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PEDIATRIC THERAPY SERVICES INC
Complete NPI Record 1407834021
Clinic/Center in Lakeland, FL

NPI Status: Active since January 04, 2006

Contact Information

1215 E ORANGE ST
LAKELAND, FL
ZIP 33801
Phone: (863) 802-3800
Fax: (863) 802-0480

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Title or Position
  24. Authorized Official Telephone Number
  25. Healthcare Provider Taxonomy Code 1
  26. Provider License Number 1
  27. Provider License Number State Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Healthcare Provider Taxonomy Code 2
  30. Healthcare Provider Primary Taxonomy Switch 2
  31. Healthcare Provider Taxonomy Code 3
  32. Provider License Number 3
  33. Provider License Number State Code 3
  34. Healthcare Provider Primary Taxonomy Switch 3
  35. Healthcare Provider Taxonomy Code 4
  36. Provider License Number 4
  37. Provider License Number State Code 4
  38. Healthcare Provider Primary Taxonomy Switch 4
  39. Healthcare Provider Taxonomy Code 5
  40. Healthcare Provider Primary Taxonomy Switch 5
  41. Other Provider Identifier 1
  42. Other Provider Identifier Type Code 1
  43. Other Provider Identifier State 1
  44. Other Provider Identifier Issuer 1
  45. Other Provider Identifier 2
  46. Other Provider Identifier Type Code 2
  47. Other Provider Identifier State 2
  48. Other Provider Identifier Issuer 2
  49. Other Provider Identifier 3
  50. Other Provider Identifier Type Code 3
  51. Other Provider Identifier State 3
  52. Other Provider Identifier Issuer 3
  53. Other Provider Identifier 4
  54. Other Provider Identifier Type Code 4
  55. Other Provider Identifier State 4
  56. Other Provider Identifier 5
  57. Other Provider Identifier Type Code 5
  58. Other Provider Identifier State 5
  59. Other Provider Identifier Issuer 5
  60. Other Provider Identifier 6
  61. Other Provider Identifier Type Code 6
  62. Other Provider Identifier State 6
  63. Other Provider Identifier 7
  64. Other Provider Identifier Type Code 7
  65. Other Provider Identifier State 7
  66. Other Provider Identifier Issuer 7
  67. Other Provider Identifier 8
  68. Other Provider Identifier Type Code 8
  69. Other Provider Identifier State 8
  70. Other Provider Identifier 9
  71. Other Provider Identifier Type Code 9
  72. Other Provider Identifier State 9
  73. Other Provider Identifier Issuer 9
  74. Other Provider Identifier 10
  75. Other Provider Identifier Type Code 10
  76. Other Provider Identifier State 10
  77. Other Provider Identifier Issuer 10
  78. Other Provider Identifier 11
  79. Other Provider Identifier Type Code 11
  80. Other Provider Identifier State 11
  81. Other Provider Identifier Issuer 11
  82. Other Provider Identifier 12
  83. Other Provider Identifier Type Code 12
  84. Other Provider Identifier State 12
  85. Other Provider Identifier Issuer 12
  86. Other Provider Identifier 13
  87. Other Provider Identifier Type Code 13
  88. Other Provider Identifier State 13
  89. Other Provider Identifier Issuer 13
  90. Other Provider Identifier 14
  91. Other Provider Identifier Type Code 14
  92. Other Provider Identifier State 14
  93. Other Provider Identifier Issuer 14
  94. Other Provider Identifier 15
  95. Other Provider Identifier Type Code 15
  96. Other Provider Identifier State 15
  97. Other Provider Identifier Issuer 15
  98. Other Provider Identifier 16
  99. Other Provider Identifier Type Code 16
  100. Other Provider Identifier State 16
  101. Other Provider Identifier Issuer 16
  102. Other Provider Identifier 17
  103. Other Provider Identifier Type Code 17
  104. Other Provider Identifier State 17
  105. Other Provider Identifier Issuer 17
  106. Other Provider Identifier 18
  107. Other Provider Identifier Type Code 18
  108. Other Provider Identifier State 18
  109. Other Provider Identifier Issuer 18
  110. Other Provider Identifier 19
  111. Other Provider Identifier Type Code 19
  112. Other Provider Identifier State 19
  113. Other Provider Identifier Issuer 19
  114. Other Provider Identifier 20
  115. Other Provider Identifier Type Code 20
  116. Other Provider Identifier State 20
  117. Other Provider Identifier Issuer 20
  118. Other Provider Identifier 21
  119. Other Provider Identifier Type Code 21
  120. Other Provider Identifier State 21
  121. Other Provider Identifier Issuer 21
  122. Is Organization Subpart
  123. Authorized Official Name Prefix Text
  124. Authorized Official Credential Text
  125. Healthcare Provider Taxonomy Group 1
  126. Healthcare Provider Taxonomy Group 2
  127. Healthcare Provider Taxonomy Group 3
  128. Healthcare Provider Taxonomy Group 4

Complete NPI Dataset

This page represents the complete record for NPI 1407834021. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1407834021
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 1215 E ORANGE STREET
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: LAKELAND
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: FL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 338015762
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 8638023800
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 8638020480
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1215 E ORANGE ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: LAKELAND
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: FL
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 33801
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8638023800
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8638020480
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 1/4/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/20/2018
The date that a record was last updated or changed.
Authorized Official Last Name: RIVA
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: DIANA
The first name of the authorized official.
Authorized Official Title or Position: PRESIDENT, OWNER, OTR
The title or position of the authorized official.
Authorized Official Telephone Number: 8638023800
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 235Z00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: SA5826
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: FL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 222Q00000X
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 2251P0200X
Provider License Number 3: PT0002549
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: FL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 225XP0200X
Provider License Number 4: OT12452
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4: FL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 261Q00000X
Healthcare Provider Primary Taxonomy Switch 5: Y
Other Provider Identifier 1: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: FL
Other Provider Identifier Issuer 1: GREAT WEST HEALTH INSURANCE
Other Provider Identifier 2: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: FL
Other Provider Identifier Issuer 2: SOUTHCARE
Other Provider Identifier 3: 664175
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: FL
Other Provider Identifier Issuer 3: AETNA HEALTHCARE
Other Provider Identifier 4: 880357900
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: FL
Other Provider Identifier 5: Y905L
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: FL
Other Provider Identifier Issuer 5: BCBS OF FL GROUP ID
Other Provider Identifier 6: 024298400
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: FL
Other Provider Identifier 7: 1407834021
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: FL
Other Provider Identifier Issuer 7: CIGNA BAYCARE
Other Provider Identifier 8: 880357904
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: FL
Other Provider Identifier 9: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: FL
Other Provider Identifier Issuer 9: HERITAGE CONSULTANTS
Other Provider Identifier 10: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: FL
Other Provider Identifier Issuer 10: BEECHSTREET
Other Provider Identifier 11: 6406221
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 11: FL
Other Provider Identifier Issuer 11: UNITED HEALTHCARE
Other Provider Identifier 12: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 12: FL
Other Provider Identifier Issuer 12: PRINCIPLE INSURANCE
Other Provider Identifier 13: 13424302
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 13: FL
Other Provider Identifier Issuer 13: CITRUS HEALTHCARE GRP ID
Other Provider Identifier 14: P10705914
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 14: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 14: FL
Other Provider Identifier Issuer 14: SIMPLY HEALTHCARE MEDICAID HMO
Other Provider Identifier 15: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 15: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 15: FL
Other Provider Identifier Issuer 15: 1ST SERVICES ADM
Other Provider Identifier 16: 6406221
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 16: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 16: FL
Other Provider Identifier Issuer 16: UNITED HEALTHCARE MEDICAID HMO
Other Provider Identifier 17: 8810363001
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 17: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 17: FL
Other Provider Identifier Issuer 17: CIGNA HEALTHCARE
Other Provider Identifier 18: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 18: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 18: FL
Other Provider Identifier Issuer 18: CHILDREN'S MEDICAL SERVICES
Other Provider Identifier 19: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 19: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 19: FL
Other Provider Identifier Issuer 19: HUMANA
Other Provider Identifier 20: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 20: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 20: FL
Other Provider Identifier Issuer 20: TRICARE
Other Provider Identifier 21: Y906F
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 21: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 21: FL
Other Provider Identifier Issuer 21: BCBS FL GROUP ID
Is Organization Subpart: N
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: OT
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP