| Name: | Pediatric PT, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 18 Jan 2017 (8 years ago) |
| Entity Number: | 000-380-984 |
| Register Number: | 000380984 |
| County: | Calhoun |
| Place of Formation: | Calhoun County |
| Registered Office Street Address: | 1106 HERITAGE LANE NEJACKSONVILLE, AL 36265 |
| Registered Office Street Address ZIP Code: | 36265 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861935033 | 2016-11-21 | 2017-02-08 | 1106 HERITAGE LN NE, JACKSONVILLE, AL, 362651255, US | 1705 LEIGHTON AVE, ANNISTON, AL, 362073832, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 256-235-2524 |
| Fax | 2562362573 |
Authorized person
| Name | MRS. TANJA ELLIOTT |
| Role | OFFICE MANAGER |
| Phone | 2562352524 |
Taxonomy
| Taxonomy Code | 225XP0200X - Pediatric Occupational Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 890001880 |
| State | AL |
| Name | Role |
|---|---|
| BENTON, JUDY | Agent |
| Name | Role | Address |
|---|---|---|
| LEGALZOOM.COM INC | Organizer | 101 N BRAND BLVD 10TH FLOORGLENDALE, CA 91203 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
