Pediatric Therapeutics PLLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

7545 Issued in NC

Legal business name

PEDIATRIC THERAPEUTICS PLLC

Practice address

5265 Sunset Lake Rd
#14
Holly Springs, NC 27540-3793

Phone

(919) 208-1521

NPI assigned

Oct 9, 2007

Organization subpart

No

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

Authorized official

Name

Jessica Provost, MS CCC-SLP

Title

Director

Phone

(919) 208-1521

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1992993588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5265 SUNSET LAKE RD",
            "address_2": "#14",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275403793",
            "telephone_number": "919-208-1521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5265 SUNSET LAKE RD",
            "address_2": "#14",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275403793",
            "telephone_number": "919-208-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC THERAPEUTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "PROVOST",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "919-208-1521",
        "authorized_official_credential": "MS CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NC",
            "license": "7545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shimul Patel
• Nicole Paterno
• Emily Proctor Payne, D.D.S
• Peak Nutrition and Weight Loss Clinic, P.a.
• Emma Rachel Peck, PA-C
• Perfectly Balanced Counseling PLLC
• Corissa Phannenstill
• Yuanlin Piao
• Andrew Gregory Pierce, MD
• Kirsten Samuelsen Pierce

• Early Intervention Provider Agency in Holly Springs, NC
• Providers in Holly Springs, NC by specialty
• Early Intervention Provider Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; 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.