NPIMap

Organization Active NPI

Peach State Pediatric Therapy Inc.

  • Specialist
  • Lawrenceville, GA
National Provider Identifier
1073630992
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
OT002948 Issued in GA
Legal business name
PEACH STATE PEDIATRIC THERAPY INC.
Practice address
457 Autumn Park Trce
Lawrenceville, GA 30044-7421
Phone
(678) 524-3451
Fax
(770) 921-7380
NPI assigned
Mar 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Margaret Ann Kuneyl, OTNPI 1770659237
Title
Ceo
Phone
(678) 524-3451

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X OT002948 GA Primary

Addresses

Primary practice location

457 Autumn Park Trce
Lawrenceville, GA 30044-7421

Mailing address

457 Autumn Park Trce
Lawrenceville, GA 30044-7421
Phone (678) 524-3451

National Provider Directory

National Provider Directory
Tax ID family
Peach State Ped Therapy Buford2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073630992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 AUTUMN PARK TRCE",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300447421",
            "telephone_number": "678-524-3451",
            "fax_number": "770-921-7380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "457 AUTUMN PARK TRCE",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300447421",
            "telephone_number": "678-524-3451",
            "fax_number": "770-921-7380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH STATE PEDIATRIC THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KUNEYL",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-524-3451",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "OT002948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.