Provider Demographics
NPI:1952921454
Name:COOPER RIVER PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:COOPER RIVER PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ZIRKSL
Authorized Official - Last Name:VON LEHE
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:843-670-3730
Mailing Address - Street 1:119 CALLIBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486
Mailing Address - Country:US
Mailing Address - Phone:803-971-9330
Mailing Address - Fax:
Practice Address - Street 1:119 CALLIBLUFF DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486
Practice Address - Country:US
Practice Address - Phone:803-971-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPER RIVER PEDIATRIC THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty