MEDICARE: PEDIATRIC PHYSICAL THERAPY SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5000	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	078H5	OTHER	NC	BCBS OF NC

General Provider Information

NPI Number	:	1104894948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PHYSICAL THERAPY SERVICES, INC

Provider Business Mailing Address
First Line	:	221 COUNTRY PLACE RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-4413
Country	:	US
Telephone Number	:	910-264-6889
Fax Number	:	910-530-3007

Provider Business Practice Location Address
First Line	:	221 COUNTRY PLACE RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-4413
Country	:	US
Telephone Number	:	910-264-6889
Fax Number	:	910-530-3007

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/PRESIDENT
Name	:	BETH ANN RIEGLER
Credential	:	PT
Telephone Number	:	910-264-6889

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	11/14/2023

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