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TRELLIS PEDIATRIC THERAPY LLC
Complete NPI Record 1255963237
Speech-Language Pathologist in York, SC

NPI Status: Active since February 07, 2020

Contact Information

2507 LOCUST HILL RD
YORK, SC
ZIP 29745
Phone: (423) 202-2123

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Authorized Official Last Name
  20. Authorized Official First Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Is Organization Subpart
  26. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1255963237. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1255963237
The city name in the mailing address of the provider being identified.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 2507 LOCUST HILL RD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: YORK
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: SC
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Mailing Address Postal Code: 297459698
The city name in the location address of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The State code in the location of the provider being identified.
Provider Business Mailing Address Telephone Number: 4232022123
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 2507 LOCUST HILL RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: YORK
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: SC
The fax number associated with the location address of the provider being identified.
Provider Business Practice Location Address Postal Code: 297459698
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Practice Location Address Country Code If outside U S : US
The date that a record was last updated or changed.
Provider Business Practice Location Address Telephone Number: 4232022123
The code designating the provider’s gender if the provider is a person.
Provider Enumeration Date: 2/7/2020
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 2/7/2020
Authorized Official Last Name: DISMUKES
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Authorized Official First Name: KIMBERLY
Authorized Official Title or Position: SLP
The title or position of the authorized official.
Authorized Official Telephone Number: 4232022123
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 235Z00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP