Organization
THERA-PEDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY L CARPENTER (INSURANCE/SECRETARY)
(919) 739-0047
Entity
Organization
Contact information
Practice address
1214 PARKWAY DRIVE, GOLDSBORO, NC 27534-3448
(919) 739-0047
(919) 739-9041
Mailing address
P.O. BOX 10723, GOLDSBORO, NC 27532-0723
(919) 739-0047
(919) 739-9041
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01525
BCBS GROUP
NC
05
—
6005202
—
NC
05
—
7210633
—
NC
Enumeration date
02/27/2006
Last updated
09/13/2010
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