Healthcare Provider Details

I. General information

NPI: 1881376101
Provider Name (Legal Business Name): PEDIACTIVITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 NEUSE BLVD STE D
NEW BERN NC
28560-4318
US

IV. Provider business mailing address

1013 BRACKEN FERN DR
NEW BERN NC
28560-7150
US

V. Phone/Fax

Practice location:
  • Phone: 232-497-8350
  • Fax: 252-999-6905
Mailing address:
  • Phone: 630-234-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SHERI LYNN IRELAND BERK
Title or Position: FOUNDER
Credential: PHYSCIAL THERAPIST
Phone: 630-234-8265