Pediatric Links,LLC

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

License

PT05002613A Issued in IN

Legal business name

PEDIATRIC LINKS,LLC

Practice address

7317 W Jefferson Blvd
Fort Wayne, IN 46804-6237

Phone

(260) 418-8051

Fax

(260) 489-3704

NPI assigned

May 10, 2011

Organization subpart

No

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

Authorized official

Name

Agnes Lucas Vigilia-Maraya, P.T.

Title

Administrator/Owner/Practitioner

Phone

(260) 418-8051

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1304985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304985600000",
    "number": "1720370794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7317 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046237",
            "telephone_number": "260-418-8051",
            "fax_number": "260-489-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7317 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046237",
            "telephone_number": "260-418-8051",
            "fax_number": "260-489-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC LINKS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-10",
        "last_updated": "2011-05-10",
        "status": "A",
        "authorized_official_last_name": "VIGILIA-MARAYA",
        "authorized_official_first_name": "AGNES",
        "authorized_official_middle_name": "LUCAS",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER/PRACTITIONER",
        "authorized_official_telephone_number": "260-418-8051",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": "IN",
            "license": "PT05002613A",
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "IN",
            "license": "PT05002613A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmental Disabilities Clinic/Center in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Developmental Disabilities Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; 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.