Provider Demographics
NPI:1427679364
Name:PERSEVERE ADULT AND PEDIATRIC REHAB., LLC
Entity type:Organization
Organization Name:PERSEVERE ADULT AND PEDIATRIC REHAB., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEADLE
Authorized Official - Suffix:
Authorized Official - Credentials:MEDCCC/SLP
Authorized Official - Phone:478-447-9591
Mailing Address - Street 1:304 PAWNEE CT
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2814
Mailing Address - Country:US
Mailing Address - Phone:478-447-9591
Mailing Address - Fax:478-224-0449
Practice Address - Street 1:304 PAWNEE CT
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2814
Practice Address - Country:US
Practice Address - Phone:478-447-9591
Practice Address - Fax:478-224-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty