Provider Demographics
NPI:1871804906
Name:ADVANCED PEDIATRIC THERAPIES,LLC
Entity type:Organization
Organization Name:ADVANCED PEDIATRIC THERAPIES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATH/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:BEMUS
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:775-825-4744
Mailing Address - Street 1:1025 ROBERTA LN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1893
Mailing Address - Country:US
Mailing Address - Phone:775-825-4744
Mailing Address - Fax:775-351-1644
Practice Address - Street 1:1025 ROBERTA LN
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1893
Practice Address - Country:US
Practice Address - Phone:775-825-4744
Practice Address - Fax:775-351-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP672251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506123Medicaid