Basic Information
| Provider Information | |||||||||
| NPI: | 1740352665 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S THERAPY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1514 ARTHUR MINNIS RD | ||||||||
| Address2: | |||||||||
| City: | HILLSBOROUGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272787493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199337720 | ||||||||
| FaxNumber: | 9199327215 | ||||||||
| Practice Location | |||||||||
| Address1: | 1514 ARTHUR MINNIS RD | ||||||||
| Address2: | |||||||||
| City: | HILLSBOROUGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272787493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199337720 | ||||||||
| FaxNumber: | 9199327215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ZENIOU | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9199337720 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | X | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 7212047 | 05 | NC | MEDICAID |