MEDICARE: LITTLE CHAMPIONS PEDIATRIC THERAPY, LLC

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	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1578414009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE CHAMPIONS PEDIATRIC THERAPY, LLC

Provider Business Mailing Address
First Line	:	301 N MAIN ST STE 1070
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27101-3836
Country	:	US
Telephone Number	:	743-444-6964
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 N MAIN ST STE 1070
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27101-3836
Country	:	US
Telephone Number	:	743-444-6964
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. MATTHEW DINKINS
Credential	:
Telephone Number	:	743-444-6964

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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