Healthcare Provider Details

I. General information

NPI: 1518226448
Provider Name (Legal Business Name): THERACCESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2012
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PEMBERTON HILL RD SUITE 102
APEX NC
27502-3957
US

IV. Provider business mailing address

1101 PEMBERTON HILL RD SUITE 102
APEX NC
27502-3957
US

V. Phone/Fax

Practice location:
  • Phone: 919-421-4263
  • Fax:
Mailing address:
  • Phone: 919-421-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6766
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number89
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number89
License Number StateNC

VIII. Authorized Official

Name: MR. CHETAN DESHMUKH
Title or Position: CEO
Credential: MBA, OTR/L, CPC,
Phone: 919-421-4263