Organization
PEDIATRIC FOUNDATIONS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINNETTE RICHARDS OTR/L (OPERATIONS MANAGER)
(727) 420-0267
Entity
Organization
Contact information
Practice address
2624 MT ISLE HARBOR DR, CHARLOTTE, NC 28214-5413
(727) 420-0267
Mailing address
2624 MT ISLE HARBOR DR, CHARLOTTE, NC 28214-5413
(727) 420-0267
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006528
OPTUM
NC
01
—
1659420040
TRICARE
NC
05
—
1659420040
—
FL
01
—
18923
BCBSNC
NC
01
—
2084
REHAB PROVIDER NETWORK
NC
Enumeration date
04/17/2019
Last updated
05/28/2019
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