Healthcare Provider Details

I. General information

NPI: 1437399979
Provider Name (Legal Business Name): INSIDEOUT BODY THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 FAYETTEVILLE RD SUITE 101
DURHAM NC
27713-9089
US

IV. Provider business mailing address

5720 FAYETTEVILLE RD SUITE 101
DURHAM NC
27713-9089
US

V. Phone/Fax

Practice location:
  • Phone: 919-361-0104
  • Fax: 919-361-0105
Mailing address:
  • Phone: 919-361-0104
  • Fax: 919-361-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9567
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number10210
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9715
License Number StateNC

VIII. Authorized Official

Name: MISCHA E ABSHIRE
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: PT, DPT, OCS
Phone: 919-361-0104