NPIMap

Organization Active NPI

Pediatric Therapy Group LLC

  • Speech-Language Pathologist
  • Baton Rouge, LA
National Provider Identifier
1053586685
Registry record updated Feb 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
4906 Issued in LA
Legal business name
PEDIATRIC THERAPY GROUP LLC
Practice address
1034 Elizabeth Dr
Baton Rouge, LA 70815-4509
Phone
(225) 921-7216
Fax
(225) 927-4059
NPI assigned
Apr 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Candice Moree Gray, M.A., CCC-SLP
Title
Owner
Phone
(225) 921-7216

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X 4906 LA Primary

Addresses

Primary practice location

1034 Elizabeth Dr
Baton Rouge, LA 70815-4509

Mailing address

1034 Elizabeth Dr
Baton Rouge, LA 70815-4509
Phone (225) 921-7216

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266364800000",
    "number": "1053586685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 ELIZABETH DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708154509",
            "telephone_number": "225-921-7216",
            "fax_number": "225-927-4059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 ELIZABETH DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708154509",
            "telephone_number": "225-921-7216",
            "fax_number": "225-927-4059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC THERAPY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2010-02-17",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_middle_name": "MOREE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "225-921-7216",
        "authorized_official_credential": "M.A., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "4906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.