Provider Demographics
NPI:1770218687
Name:SENSATIONAL PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:SENSATIONAL PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GYOERKOE
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:704-438-5966
Mailing Address - Street 1:1104 LYTTON LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-6835
Mailing Address - Country:US
Mailing Address - Phone:704-438-5966
Mailing Address - Fax:980-346-5376
Practice Address - Street 1:1104 LYTTON LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-6835
Practice Address - Country:US
Practice Address - Phone:704-438-5966
Practice Address - Fax:980-346-5376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty