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General NPI Number Information
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NPI Number | 1396819736
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Entity Type | Organization
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Legal Business Name | PEDIATRIC FEEDING AND SPEECH THERAPY ASSOCIATES, PA
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Dates
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Enumeration Date | 11/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8820 BLOOMING ARBOR ST
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5602
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Country | US
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Telephone | 704-619-2167
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Fax | 704-948-6963
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Provider Business Mailing Address
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Address Line | PO BOX 601
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City | HUNTERSVILLE
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State | NC
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Zip | 28070-0601
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Country | US
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Telephone | 704-619-2167
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Fax | 704-948-6963
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | GLEN MOWERS
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Credential |
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Telephone | 704-619-2167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4252
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License Number State | NC
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