Organization
PEDIATRIC THERAPEUTICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA PROVOST MS CCC-SLP (DIRECTOR)
(919) 208-1521
Entity
Organization
Contact information
Practice address
5265 SUNSET LAKE RD, #14, HOLLY SPRINGS, NC 27540-3793
(919) 208-1521
Mailing address
5265 SUNSET LAKE RD, #14, HOLLY SPRINGS, NC 27540-3793
(919) 208-1521
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
7545
NC
Other
Enumeration date
10/09/2007
Last updated
10/09/2007
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