NPI 1477991560

Mini Miracles Pediatric Therapy, PLLC

Organisation Early Intervention Provider Agency Johnson City, TN

Practice location

Address: 2214 E Fairview Ave, Johnson City, TN 37601-2860
Phone: (423) 928-6464
Fax: (423) 232-7970
Mailing address: PO Box 191, Johnson City, TN 37605-0191

Authorised official

Name: Douglas Edwin Brown
Title: Ceo/Owner
Phone: (601) 624-1237

Registered specialties (2)

Early Intervention Provider Agency Primary

Agencies Taxonomy 252Y00000X Licence 4611 (VA)

Other Early Intervention Provider Agency providers in Tennessee →

Developmentally Disabled Services Day Training Agency

Agencies Taxonomy 251C00000X Licence 0119003962 (VA)

Other Day Training, Developmentally Disabled Services providers in Tennessee →

Registry record

NPI: 1477991560
Entity type: Organization
NPI issued: 11 Jun 2013
Record last updated: 3 Oct 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.