Healthcare Provider Details

I. General information

NPI: 1851645311
Provider Name (Legal Business Name): CAROLINA PROGRESSIVE THERAPY SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SCOTT AVE
HIGH POINT NC
27262-7834
US

IV. Provider business mailing address

1104 GREENWAY DR
HIGH POINT NC
27262-2843
US

V. Phone/Fax

Practice location:
  • Phone: 336-207-8957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MARGARET GRAYSON PORTER
Title or Position: PRESIDENT
Credential:
Phone: 336-207-8957