Healthcare Provider Details

I. General information

NPI: 1225436264
Provider Name (Legal Business Name): TRULY THERAPEUTIC REHAB SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 PERIMETER PKWY SUITE 200
CHARLOTTE NC
28216-2447
US

IV. Provider business mailing address

PO BOX 142
WAKE FOREST NC
27588-0142
US

V. Phone/Fax

Practice location:
  • Phone: 919-793-3396
  • Fax: 704-602-5212
Mailing address:
  • Phone: 919-793-3396
  • Fax: 704-602-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number8544
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SCOTILLIA NOEL FOGG
Title or Position: OWNER
Credential: OTR/L
Phone: 919-793-3396