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General NPI Number Information
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NPI Number | 1578751921
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Entity Type | Organization
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Legal Business Name | PEDS CARE INC
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 7000 JOYFUL NOISE LN
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-7810
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Country | US
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Telephone | 704-219-6246
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 JOYFUL NOISE LN
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-7810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MPT
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Name | KUNJAL PATEL
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Credential |
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Telephone | 704-219-6246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3009
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License Number State | NC
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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 | 10001
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License Number State | NC
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