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General NPI Number Information
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NPI Number | 1013426980
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Entity Type | Organization
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Legal Business Name | INTEGRATED PEDIATRIC THERAPIES
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Dates
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Enumeration Date | 09/23/2017
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 138 MEMORY PLZ
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City | WHITEVILLE
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State | NC
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Zip | 28472-2640
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Country | US
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Telephone | 910-393-9749
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Fax | 910-250-1244
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Provider Business Mailing Address
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Address Line | 3260 OCEANIC BAY DR
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City | SOUTHPORT
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State | NC
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Zip | 28461-6401
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Country | US
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Telephone | 203-217-9366
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Fax | 910-393-9749
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Authorized Official
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Title or Position | OWNER AND THERAPIST
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Name | MR. JEFFREY W WICKLINE
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Credential | OTR
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Telephone | 203-217-9366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 9721
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1758
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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