Healthcare Provider Details

I. General information

NPI: 1316701410
Provider Name (Legal Business Name): GREENSBORO CEREBRAL PALSY ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
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: 336-663-1957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARIAN STEIN
Title or Position: BOARD DIRECTOR
Credential:
Phone: 336-707-4880