Provider Demographics
NPI:1447447180
Name:PEDIATRIC THERAPY ASSOCIATES OF FW
Entity type:Organization
Organization Name:PEDIATRIC THERAPY ASSOCIATES OF FW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:FINCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-589-7033
Mailing Address - Street 1:7500 PEBBLE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-6979
Mailing Address - Country:US
Mailing Address - Phone:817-589-7033
Mailing Address - Fax:817-595-1178
Practice Address - Street 1:7500 PEBBLE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-6979
Practice Address - Country:US
Practice Address - Phone:817-589-7033
Practice Address - Fax:817-595-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014991225100000X
TX109584225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty