Provider Demographics
NPI:1912691106
Name:MINT HILL PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:MINT HILL PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETCU
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:980-253-2373
Mailing Address - Street 1:2217 MATTHEWS TOWNSHIP PKWY
Mailing Address - Street 2:STE D 175
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:980-253-2373
Mailing Address - Fax:
Practice Address - Street 1:6040 GOLD WAGON LN
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9351
Practice Address - Country:US
Practice Address - Phone:980-253-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty