Provider Demographics
NPI:1871769349
Name:PEDIATRIC THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:PEDIATRIC THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-662-1060
Mailing Address - Street 1:206 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4617
Mailing Address - Country:US
Mailing Address - Phone:813-662-1060
Mailing Address - Fax:813-662-0530
Practice Address - Street 1:206 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510
Practice Address - Country:US
Practice Address - Phone:813-662-1060
Practice Address - Fax:813-662-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT59902251P0200X
FLOT1478225XP0200X
FLSA7398235Z00000X
261Q00000X
FLPT2549332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024393800Medicaid
FL6406221OtherUNITED HEALTHCARE
FL8803579-04Medicaid
FL8810363001OtherCIGNA
FLY906FOtherBLUE CROSS BLUE SHIELD
FL664175OtherAETNA
FL13424302OtherCITRUS COMMERCIAL/HMO
FL8803579-01Medicaid