Provider Demographics
NPI:1053478461
Name:ANTLEY PEDIATRIC THERAPY, CORP.
Entity Type:Organization
Organization Name:ANTLEY PEDIATRIC THERAPY, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:704-236-3895
Mailing Address - Street 1:7275 WOODCOCK TRL
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-7705
Mailing Address - Country:US
Mailing Address - Phone:704-236-3895
Mailing Address - Fax:318-345-6997
Practice Address - Street 1:7275 WOODCOCK TRL
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-7705
Practice Address - Country:US
Practice Address - Phone:704-236-3895
Practice Address - Fax:318-345-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53412251P0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211749Medicaid