Pediatric Promise Therapy Specialists, Inc

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

9066 Issued in NC

Legal business name

PEDIATRIC PROMISE THERAPY SPECIALISTS, INC

Doing business as

Pediatric Promise

Practice address

1523 Anthem CT
Charlotte, NC 28205-7980

Phone

(704) 559-9010

Fax

(704) 900-7383

NPI assigned

Nov 19, 2013

Last updated

Nov 19, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Leigh Megan Justice, MSP CCC-SLP

Title

President/Owner

Phone

(704) 559-9010

Specialties & licenses 1

Addresses

Other names 1

• Pediatric Promise Doing business as

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

{
    "created_epoch": "1384819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384819200000",
    "number": "1073943585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1523 ANTHEM CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282057980",
            "telephone_number": "704-559-9010",
            "fax_number": "704-900-7383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1523 ANTHEM CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282057980",
            "telephone_number": "704-559-9010",
            "fax_number": "704-900-7383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PROMISE THERAPY SPECIALISTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-19",
        "last_updated": "2013-11-19",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "LEIGH",
        "authorized_official_middle_name": "MEGAN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "704-559-9010",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSP CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "9066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Promise",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2013; 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.