Provider Demographics
NPI:1508557802
Name:PROPEL PEDIATRIC THERAPY, INC.
Entity Type:Organization
Organization Name:PROPEL PEDIATRIC THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CETTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:404-228-8558
Mailing Address - Street 1:2 CORPORATE BLVD NE STE 160
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2027
Mailing Address - Country:US
Mailing Address - Phone:404-228-8558
Mailing Address - Fax:
Practice Address - Street 1:2 CORPORATE BLVD NE STE 160
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2027
Practice Address - Country:US
Practice Address - Phone:404-228-8558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000860604DMedicaid