Healthcare Provider Details

I. General information

NPI: 1225966351
Provider Name (Legal Business Name): HOMESTRIDES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 HAWKS BLUFF CT
WAKE FOREST NC
27587-3398
US

IV. Provider business mailing address

409 HAWKS BLUFF CT
WAKE FOREST NC
27587-3398
US

V. Phone/Fax

Practice location:
  • Phone: 201-424-3301
  • Fax:
Mailing address:
  • Phone: 201-424-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: VICTOR MANDANAS
Title or Position: PT
Credential: PT
Phone: 201-424-3301