Provider Demographics
NPI:1316073422
Name:PEDIATRIC THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:PEDIATRIC THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MURRELL
Authorized Official - Last Name:MATTOCKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:336-852-4865
Mailing Address - Street 1:2712 KIVETT DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-9744
Mailing Address - Country:US
Mailing Address - Phone:336-852-4865
Mailing Address - Fax:336-852-5413
Practice Address - Street 1:2712 KIVETT DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-9744
Practice Address - Country:US
Practice Address - Phone:336-852-4865
Practice Address - Fax:336-852-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210590Medicaid