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General NPI Number Information
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NPI Number | 1841839644
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Entity Type | Organization
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Legal Business Name | SOARING THERAPY AND LEARNING CENTER, INC.
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Dates
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Enumeration Date | 12/27/2019
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 273 QUILLIAN ST
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City | CLEVELAND
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State | GA
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Zip | 30528-1464
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Country | US
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Telephone | 706-201-9661
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Fax |
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Provider Business Mailing Address
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Address Line | 329 TEEL MOUNTAIN DRIVE
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City | CLEVELAND
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State | GA
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Zip | 30528-0710
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Country | US
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Telephone | 706-201-9661
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE GOODMAN
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Credential | OT
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Telephone | 706-201-9661
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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 | 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 #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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