1295704534 NPI number — CAROLINA PEDIATRIC THERAPY

Table of content: (NPI 1295704534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295704534 NPI number — CAROLINA PEDIATRIC THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA PEDIATRIC THERAPY
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:
CAROLINA PEDIATRIC OCCUPATIONAL THERAPY CAROLINA PED THERAPY COOP INC
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:
1295704534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 HAMPTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-980-4900
Provider Business Mailing Address Fax Number:
803-980-4902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 HAMPTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-980-4900
Provider Business Practice Location Address Fax Number:
803-980-4902
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STANTON
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
CARVETH
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
803-980-4900

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4746 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X , with the licence number: 430 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X , with the licence number: 3399 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: GP3468 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com