1164696738 NPI number — A PIECE OF THE PUZZLE THERAPY INC

Table of content: (NPI 1164696738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164696738 NPI number — A PIECE OF THE PUZZLE THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A PIECE OF THE PUZZLE THERAPY INC
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:
Provider Other Organization Name Type Code:
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:
1164696738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 N BELAIR SQ
Provider Second Line Business Mailing Address:
SUITE 19
Provider Business Mailing Address City Name:
EVANS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30809-4321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
710-290-5869
Provider Business Mailing Address Fax Number:
888-502-7262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 N BELAIR SQ
Provider Second Line Business Practice Location Address:
SUITE 19
Provider Business Practice Location Address City Name:
EVANS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30809-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
710-290-5869
Provider Business Practice Location Address Fax Number:
888-502-7262
Provider Enumeration Date:
04/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
BUFFY
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH PATHOLOGIST/OWNER
Authorized Official Telephone Number:
719-290-5869

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003128389A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82022020 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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