Provider Demographics
NPI:1942772975
Name:WEE CARE PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:WEE CARE PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:404-414-2796
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:GA
Mailing Address - Zip Code:31307-0669
Mailing Address - Country:US
Mailing Address - Phone:404-414-2796
Mailing Address - Fax:440-556-6007
Practice Address - Street 1:335 OLD RAIL RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:GA
Practice Address - Zip Code:31302-4025
Practice Address - Country:US
Practice Address - Phone:404-414-2796
Practice Address - Fax:440-556-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003181906CMedicaid