1588729859 NPI number — FIRST STEPS PEDIATRIC THERAPY INC

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 1588729859 NPI number — FIRST STEPS PEDIATRIC THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST STEPS PEDIATRIC 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:
1588729859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7017 PROVIDENCE RD S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAXHAW
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28173-7434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-256-4281
Provider Business Mailing Address Fax Number:
704-256-4282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2711 RANDOLPH RD
Provider Second Line Business Practice Location Address:
509
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28207-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-491-1455
Provider Business Practice Location Address Fax Number:
704-256-4282
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEMELLO
Authorized Official First Name:
ROSEMARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT-CLINICAL DIRECTOR
Authorized Official Telephone Number:
704-256-4281

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 8271 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X , with the licence number: 7633 , 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)

  • Identifier: 7212073 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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