Healthcare Provider Details

I. General information

NPI: 1225459605
Provider Name (Legal Business Name): PEDIATRIC THERAPY NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 SOUTHGATE CORPORATE PARK SW
HICKORY NC
28602-1518
US

IV. Provider business mailing address

PO BOX 1290
HICKORY NC
28603-1290
US

V. Phone/Fax

Practice location:
  • Phone: 828-358-3115
  • Fax: 866-433-2198
Mailing address:
  • Phone: 828-358-3115
  • Fax: 866-433-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8732
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number8732
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number52602014002
License Number StateNC

VIII. Authorized Official

Name: HEATHER BUCKLEY LANDRY
Title or Position: OWNER/PHYSICAL THERPAIST
Credential: PT
Phone: 828-358-3115