Organization Name: | CHILDREN'S PLACE PEDIATRIC THERAPIES, LLC |
NPI Number: | 1083099394 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAMITA WATKINS-AMICK (SOLE MEMBER) |
Mailing Address: | 5760 Bunch Rd Oak Ridge |
State: | NC US |
Postal Code: | 273109742 |
Phone Number: | 3363829797 |
Fax Number: | |
NPI Enumeration Date: | 07/28/2015 |
NPI Last Update Date: | 07/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0400X |
License Number: | P13476 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |