PEDIATRIC DEVELOPMENTAL THERAPY NPI 1710183991

NPI Information

NPI: 1710183991
Provider Name: PEDIATRIC DEVELOPMENTAL THERAPY
Classification: Rehabilitation Practitioner - 225400000X
Entity Type: Organization
Address: 1289 OLIVER ST
FAYETTEVILLE, NC
ZIP 28304
Phone: (910) 483-8331

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NPI Details

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 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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251S00000X	Community/Behavioral Health				No
2	225400000X	Rehabilitation Practitioner			NORTH CAROLINA	Yes

Other Identifiers

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

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	8301184	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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