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General NPI Number Information
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NPI Number | 1396073250
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PARTNERS OF NC, INC
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 325 ALEXANDER ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5752
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Country | US
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Telephone | 910-920-3838
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Fax | 910-920-1068
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Provider Business Mailing Address
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Address Line | 325 ALEXANDER ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5752
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Country | US
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Telephone | 910-920-3838
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Fax | 910-920-1068
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LISA S WHITTENTON
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Credential | OTR/L
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Telephone | 910-920-3838
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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 | 3830
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0538
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License Number State | NC
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