Provider Demographics
NPI:1881376101
Name:PEDIACTIVITY LLC
Entity type:Organization
Organization Name:PEDIACTIVITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:IRELAND BERK
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSCIAL THERAPIST
Authorized Official - Phone:630-234-8265
Mailing Address - Street 1:1013 BRACKEN FERN DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-7150
Mailing Address - Country:US
Mailing Address - Phone:630-234-8265
Mailing Address - Fax:
Practice Address - Street 1:2111 NEUSE BLVD STE D
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4318
Practice Address - Country:US
Practice Address - Phone:232-497-8350
Practice Address - Fax:252-999-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty