Healthcare Provider Details

I. General information

NPI: 1700192952
Provider Name (Legal Business Name): THERAPYWORKS PEDIATRIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 VETERINARY WAY STE 3
LEESBURG GA
31763-5667
US

IV. Provider business mailing address

130 VETERINARY WAY STE 3
LEESBURG GA
31763-5667
US

V. Phone/Fax

Practice location:
  • Phone: 229-496-5222
  • Fax: 229-219-7914
Mailing address:
  • Phone: 229-496-5222
  • Fax: 229-219-7914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: LESLIE RAWLINGS
Title or Position: OWNER/CEO
Credential:
Phone: 229-496-5222