Provider Demographics
NPI:1710393947
Name:ABC PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:ABC PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGAUGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:843-240-0018
Mailing Address - Street 1:371 ALMA ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-5714
Mailing Address - Country:US
Mailing Address - Phone:843-240-0018
Mailing Address - Fax:
Practice Address - Street 1:371 ALMA ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-5714
Practice Address - Country:US
Practice Address - Phone:843-240-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty