Healthcare Provider Details

I. General information

NPI: 1407039894
Provider Name (Legal Business Name): IMAGINATION THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 HARP ST
RALEIGH NC
27604-1303
US

IV. Provider business mailing address

1179 HARP ST
RALEIGH NC
27604-1303
US

V. Phone/Fax

Practice location:
  • Phone: 919-324-1881
  • Fax: 919-324-1781
Mailing address:
  • Phone: 919-324-1881
  • Fax: 919-324-1781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5739
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. SUNITA MURTY-GAMI
Title or Position: MANAGER OCCUPATIONAL THERAPIST
Credential: MS OTRL ITFS
Phone: 314-749-9654