Healthcare Provider Details

I. General information

NPI: 1295704534
Provider Name (Legal Business Name): CAROLINA PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 HAMPTON ST
ROCK HILL SC
29730
US

IV. Provider business mailing address

129 HAMPTON ST
ROCK HILL SC
29730
US

V. Phone/Fax

Practice location:
  • Phone: 803-980-4900
  • Fax: 803-980-4902
Mailing address:
  • Phone: 803-980-4900
  • Fax: 803-980-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4746
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number430
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3399
License Number StateSC

VIII. Authorized Official

Name: MRS. KATHERINE CARVETH STANTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 803-980-4900