Provider Demographics
NPI:1801963475
Name:PIEDMONT THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:PIEDMONT THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP
Authorized Official - Phone:910-599-6994
Mailing Address - Street 1:8810 LAUREL RUN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6162
Mailing Address - Country:US
Mailing Address - Phone:910-599-6994
Mailing Address - Fax:704-274-9212
Practice Address - Street 1:8810 LAUREL RUN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6162
Practice Address - Country:US
Practice Address - Phone:910-599-6994
Practice Address - Fax:704-274-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11945OtherBLUE CROSS BLUE SHIELD NC
NC7211429Medicaid
NC7411551Medicaid