1033356886 NPI number — A CHILD'S WAY THERAPY LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033356886 NPI number — A CHILD'S WAY THERAPY LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A CHILD'S WAY THERAPY LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DEVELOPMENTAL PEDIATRIC SKILLS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033356886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5241 WILDMARSH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27613-6571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-345-3411
Provider Business Mailing Address Fax Number:
919-845-6224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5241 WILDMARSH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27613-6571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-345-3411
Provider Business Practice Location Address Fax Number:
919-845-6224
Provider Enumeration Date:
01/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GUNNER
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
KLEKAMP
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
919-345-3411

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  3879 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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