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General NPI Number Information
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NPI Number | 1831081751
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Entity Type | Organization
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Legal Business Name | KINETIC PEDIATRIC THERAPY, INC.
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 1540 E ARLINGTON BLVD
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City | GREENVILLE
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State | NC
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Zip | 27858-5870
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Country | US
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Telephone | 252-902-7061
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Fax | 252-364-2863
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Provider Business Mailing Address
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Address Line | 1540 E ARLINGTON BLVD
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City | GREENVILLE
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State | NC
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Zip | 27858-5870
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Country | US
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Telephone | 252-902-7061
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Fax | 252-364-2863
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Authorized Official
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Title or Position | CO-OWNER
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Name | CHARLIE DAVID EDWARDS
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Credential | DPT
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Telephone | 252-902-7061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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