Provider Demographics
NPI:1558414144
Name:SPEECH THERAPY EAST
Entity Type:Organization
Organization Name:SPEECH THERAPY EAST
Other - Org Name:TRI- THERAPY EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SP
Authorized Official - Phone:252-756-3099
Mailing Address - Street 1:200 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9418
Mailing Address - Country:US
Mailing Address - Phone:252-756-3099
Mailing Address - Fax:252-756-0667
Practice Address - Street 1:200 BUCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9418
Practice Address - Country:US
Practice Address - Phone:252-756-3099
Practice Address - Fax:252-756-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210252Medicaid