| NPI | 1205118429 |
|---|---|
| Doing Business As | ST JUDES PT- PEDIATRIC SERVICES |
| Entity Type | Organization |
| Authorized Contact | KEISHA E JOHN Owner 718-238-0311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: NY 028641) |
| Additional Taxonomies | 225XP0200X Occupational Therapist Pediatrics (Licence: NY 015866) |
| 235Z00000X Speech-Language Pathologist | |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |