Provider Demographics
NPI:1225459605
Name:PEDIATRIC THERAPY NETWORK
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERPAIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:BUCKLEY
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:828-358-3115
Mailing Address - Street 1:PO BOX 1290
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-1290
Mailing Address - Country:US
Mailing Address - Phone:828-358-3115
Mailing Address - Fax:866-433-2198
Practice Address - Street 1:1040 SOUTHGATE CORPORATE PARK SW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1518
Practice Address - Country:US
Practice Address - Phone:828-358-3115
Practice Address - Fax:866-433-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8732225100000X, 2251P0200X
225X00000X, 225XF0002X, 225XP0200X, 235Z00000X
NC52602014002251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1528378171Medicaid