Provider Demographics
NPI:1417709676
Name:UPLIFT PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:UPLIFT PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:JADE
Authorized Official - Last Name:HUGHES WESTMORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:336-401-0576
Mailing Address - Street 1:920 LAUREL SPRINGS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-9718
Mailing Address - Country:US
Mailing Address - Phone:336-401-0576
Mailing Address - Fax:
Practice Address - Street 1:127 N FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3315
Practice Address - Country:US
Practice Address - Phone:336-401-0576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty