Healthcare Provider Details

I. General information

NPI: 1134265176
Provider Name (Legal Business Name): GREENSBORO CEREBRAL PALSY ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 E WENDOVER AVE
GREENSBORO NC
27405-6431
US

IV. Provider business mailing address

3205 E WENDOVER AVE
GREENSBORO NC
27405-6431
US

V. Phone/Fax

Practice location:
  • Phone: 336-375-2575
  • Fax: 336-375-2481
Mailing address:
  • Phone: 336-375-2575
  • Fax: 336-375-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA MIXSON LYON
Title or Position: EXECUTIVE DIRECTOR
Credential: M. ED.
Phone: 336-375-3575