MEDICARE: PIEDMONT 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	235Z00000X	Speech-Language Pathologist	5025	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11945	OTHER	NC	BLUE CROSS BLUE SHIELD NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801963475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT THERAPY SERVICES, INC.

Provider Business Mailing Address
First Line	:	8810 LAUREL RUN DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-6162
Country	:	US
Telephone Number	:	910-599-6994
Fax Number	:	704-274-9212

Provider Business Practice Location Address
First Line	:	8810 LAUREL RUN DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-6162
Country	:	US
Telephone Number	:	910-599-6994
Fax Number	:	704-274-9212

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MS. AMY RANDOLPH
Credential	:	M.ED. CCC-SLP
Telephone Number	:	910-599-6994

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	06/01/2011

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Directions to “PIEDMONT THERAPY SERVICES, INC. ” Practice Location

Language	Start Address	Practice Location

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