Healthcare Provider Details

I. General information

NPI: 1467743005
Provider Name (Legal Business Name): PEDIATRIC THERAPYWORKS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2011
Last Update Date: 05/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 GRANDVIEW CLUB RD
PFAFFTOWN NC
27040-9704
US

IV. Provider business mailing address

3504 GRANDVIEW CLUB RD
PFAFFTOWN NC
27040-9704
US

V. Phone/Fax

Practice location:
  • Phone: 336-407-9753
  • Fax: 336-923-4399
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number7742
License Number StateNC

VIII. Authorized Official

Name: EILEEN COLEMAN
Title or Position: PRESIDENT
Credential: MPT
Phone: 336-407-9753