MEDICARE: FIRST CONNECT PEDIATRIC THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1134064934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CONNECT PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	400 BLEVINS RUN
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-4186
Country	:	US
Telephone Number	:	757-329-4102
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 BLEVINS RUN
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-4186
Country	:	US
Telephone Number	:	757-329-4102
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	CHERIE LEE ROSE
Credential	:	SLP
Telephone Number	:	757-329-4102

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “FIRST CONNECT PEDIATRIC THERAPY ” Practice Location

Language	Start Address	Practice Location

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