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NPI Code Detail

MEDICARE: GOLDEN KEYS PEDIATRIC WELLNESS, LLC

MEDICARE: GOLDEN KEYS PEDIATRIC WELLNESS, LLC
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
1252Y00000XEarly Intervention Provider Agency

General Provider Information

NPI Number : 1326822875
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLDEN KEYS PEDIATRIC WELLNESS, LLC
Provider Business Mailing Address
First Line : 3455 VIEW AVE
Second Line :
City : ROANOKE
State : VA
Zip : 24018-3736
Country : US
Telephone Number : 262-364-7044
Fax Number :
Provider Business Practice Location Address
First Line : 3455 VIEW AVE
Second Line :
City : ROANOKE
State : VA
Zip : 24018-3736
Country : US
Telephone Number : 262-364-7044
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MEGHAN OWENS
Credential : PT
Telephone Number : 262-364-7044
Provider Enumeration Date : 08/23/2023
Last Update Date : 08/23/2023

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Directions to “GOLDEN KEYS PEDIATRIC WELLNESS, LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.