Provider Demographics
NPI:1487842407
Name:FULL CIRCLE PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:FULL CIRCLE PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:704-606-4972
Mailing Address - Street 1:1004 ROSEWATER LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3712
Mailing Address - Country:US
Mailing Address - Phone:704-606-4972
Mailing Address - Fax:
Practice Address - Street 1:1004 ROSEWATER LN
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3712
Practice Address - Country:US
Practice Address - Phone:704-606-4972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38812251P0200X
NC3009225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty