Provider Demographics
NPI:1831243450
Name:CHILDWORKS THERAPY, LLC
Entity type:Organization
Organization Name:CHILDWORKS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PCS
Authorized Official - Phone:704-575-2670
Mailing Address - Street 1:8257 TRADD CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7297
Mailing Address - Country:US
Mailing Address - Phone:704-575-2670
Mailing Address - Fax:704-553-7587
Practice Address - Street 1:8257 TRADD CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-7297
Practice Address - Country:US
Practice Address - Phone:704-575-2670
Practice Address - Fax:704-553-7587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40032251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD3557OtherMEDCOST
NC721041GMedicaid
NC0796NOtherBLUE CROSS BLUE SHIELD
NC0004526411OtherAETNA