Provider Demographics
NPI:1366529331
Name:BEARDEN PEDIATRIC THERAPY, INC.
Entity type:Organization
Organization Name:BEARDEN PEDIATRIC THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PCS
Authorized Official - Phone:770-363-2020
Mailing Address - Street 1:6470 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8501
Mailing Address - Country:US
Mailing Address - Phone:770-363-2020
Mailing Address - Fax:770-889-7719
Practice Address - Street 1:6470 CONCORD RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8501
Practice Address - Country:US
Practice Address - Phone:770-363-2020
Practice Address - Fax:770-889-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0033432251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52820847002OtherBLUE CROSS BLUE SHIELD