PEDIATRIC DEVELOPMENTAL THERAPY NPI 1710183991

NPI Information

PEDIATRIC DEVELOPMENTAL THERAPY is a rehabilitation practitioner in Fayetteville, NC. The provider is a health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. PEDIATRIC DEVELOPMENTAL THERAPY NPI is 1710183991. The provider is registered as an organization entity type.

The provider's business location address is:

1289 OLIVER ST
FAYETTEVILLE, NC
ZIP 28304-450
Phone: (910) 483-8331
Fax: (910) 483-8335

The provider's authorized official is Haden Payne Boliek .
The authorized official title is Owner and has the following contact phone number (910) 483-8331.

The CLIA number assigned to this NPI record is 34D2152883 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/25/2007 and was last updated on 8/15/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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