Healthcare Provider Details

I. General information

NPI: 1578751921
Provider Name (Legal Business Name): PEDS CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 JOYFUL NOISE LN
INDIAN TRAIL NC
28079-7810
US

IV. Provider business mailing address

7000 JOYFUL NOISE LN
INDIAN TRAIL NC
28079-7810
US

V. Phone/Fax

Practice location:
  • Phone: 704-219-6246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number10001
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3009
License Number StateNC

VIII. Authorized Official

Name: KUNJAL PATEL
Title or Position: MPT
Credential:
Phone: 704-219-6246