Organization
ABC PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLI BENTSEN PT (MANAGER)
(919) 693-1671
Entity
Organization
Contact information
Practice address
153 OLD WAREHOUSE SQ, OXFORD, NC 27565-2957
(919) 693-1671
Mailing address
1010 BROOKS BAY DR, ERIE, PA 16505-5706
(252) 213-0001
(919) 693-9381
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013P7
BCBS GROUP NUMBER
NC
05
—
102970525002
—
PA
05
—
7211211
—
NC
05
—
8300020
—
NC
Enumeration date
05/02/2006
Last updated
07/30/2020
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