Healthcare Provider Details

I. General information

NPI: 1396073250
Provider Name (Legal Business Name): PEDIATRIC PARTNERS OF NC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ALEXANDER ST
FAYETTEVILLE NC
28301-5752
US

IV. Provider business mailing address

325 ALEXANDER ST
FAYETTEVILLE NC
28301-5752
US

V. Phone/Fax

Practice location:
  • Phone: 910-920-3838
  • Fax: 910-920-1068
Mailing address:
  • Phone: 910-920-3838
  • Fax: 910-920-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3830
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0538
License Number StateNC

VIII. Authorized Official

Name: MRS. LISA S WHITTENTON
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 910-920-3838