Provider Demographics
NPI:1467639955
Name:COLUMBUS PEDIATRIC THERAPY, INC.
Entity Type:Organization
Organization Name:COLUMBUS PEDIATRIC THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLY
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:VALAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:910-625-5443
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:NAKINA
Mailing Address - State:NC
Mailing Address - Zip Code:28455-0220
Mailing Address - Country:US
Mailing Address - Phone:910-625-5443
Mailing Address - Fax:910-641-4152
Practice Address - Street 1:3450 JAMES B WHITE HWY S
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-8678
Practice Address - Country:US
Practice Address - Phone:910-625-5443
Practice Address - Fax:910-641-4152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200167Medicaid