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General NPI Number Information
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NPI Number | 1124086822
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Entity Type | Organization
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Legal Business Name | ABC PEDIATRIC THERAPY, LLC
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 153 OLD WAREHOUSE SQ
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City | OXFORD
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State | NC
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Zip | 27565-2957
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Country | US
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Telephone | 919-693-1671
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 BROOKS BAY DR
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City | ERIE
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State | PA
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Zip | 16505-5706
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Country | US
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Telephone | 252-213-0001
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Fax | 919-693-9381
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. KELLI BENTSEN
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Credential | PT
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Telephone | 919-693-1671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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