Healthcare Provider Details

I. General information

NPI: 1982421715
Provider Name (Legal Business Name): GROWING MINDS PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914B WESTBROOK DR
CHARLOTTE NC
28202-3352
US

IV. Provider business mailing address

914B WESTBROOK DR
CHARLOTTE NC
28202-3352
US

V. Phone/Fax

Practice location:
  • Phone: 980-224-3894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BOWEN PIRTLE
Title or Position: FOUNDER
Credential: MS, CCC-SLP
Phone: 980-224-3894