| Organization Name: | INNOVATIVE PEDIATRIC THERAPIES PT OT SLP PLLC |
| NPI Number: | 1023304995 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISE PETRICONE (PRESIDENT) |
| Mailing Address: | 31 Burd St Nyack |
| State: | NY US |
| Postal Code: | 109603205 |
| Phone Number: | 8453533331 |
| Fax Number: | |
| NPI Enumeration Date: | 06/20/2011 |
| NPI Last Update Date: | 09/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0700X |
| License Number: | 003760-1 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Hearing and Speech |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, prescriptive, and therapy services related to congenital and acquired conditions and diseases that affect hearing capacity and speech ability. |