Provider Demographics
NPI:1073943585
Name:PEDIATRIC PROMISE THERAPY SPECIALISTS, INC
Entity type:Organization
Organization Name:PEDIATRIC PROMISE THERAPY SPECIALISTS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:MEGAN
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:MSP CCC-SLP
Authorized Official - Phone:704-559-9010
Mailing Address - Street 1:1523 ANTHEM CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7980
Mailing Address - Country:US
Mailing Address - Phone:704-559-9010
Mailing Address - Fax:704-900-7383
Practice Address - Street 1:1523 ANTHEM CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7980
Practice Address - Country:US
Practice Address - Phone:704-559-9010
Practice Address - Fax:704-900-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty