Healthcare Provider Details

I. General information

NPI: 1891761060
Provider Name (Legal Business Name): THERA-PEDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 PARKWAY DRIVE
GOLDSBORO NC
27534-3448
US

IV. Provider business mailing address

P.O. BOX 10723
GOLDSBORO NC
27532-0723
US

V. Phone/Fax

Practice location:
  • Phone: 919-739-0047
  • Fax: 919-739-9041
Mailing address:
  • Phone: 919-739-0047
  • Fax: 919-739-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JUDY L CARPENTER
Title or Position: INSURANCE/SECRETARY
Credential:
Phone: 919-739-0047