Southern Piedmont Pediatric Therapy, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

SOUTHERN PIEDMONT PEDIATRIC THERAPY, LLC

Practice address

1028 Antioch Woods LN
Matthews, NC 28104-7406

Phone

(704) 604-2585

NPI assigned

Jan 17, 2025

Organization subpart

No

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

Authorized official

Name

Garret Tommasulo

Title

Member/Manager

Phone

(704) 604-2585

Specialties & licenses 1

Addresses

Other names 1

• Southern Piedmont Pediatric Therapy Other name

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

{
    "created_epoch": "1737072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1144031121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 ANTIOCH WOODS LN",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281047406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 ANTIOCH WOODS LN",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281047406",
            "telephone_number": "704-604-2585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PIEDMONT PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-17",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-16",
        "status": "A",
        "authorized_official_last_name": "TOMMASULO",
        "authorized_official_first_name": "GARRET",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "704-604-2585"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Piedmont Pediatric Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Occupational Therapist in Matthews, NC
• Providers in Matthews, NC by specialty
• Occupational Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; 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.