Healthcare Provider Details

I. General information

NPI: 1730637885
Provider Name (Legal Business Name): SOUTHEASTERN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 WEAVER BLVD STE H
WEAVERVILLE NC
28787-6317
US

IV. Provider business mailing address

23 TURTLE CREEK DR
ASHEVILLE NC
28803-3152
US

V. Phone/Fax

Practice location:
  • Phone: 828-484-9415
  • Fax: 828-484-9478
Mailing address:
  • Phone: 828-274-2188
  • Fax: 828-274-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DARREN MICHAEL CADY
Title or Position: OWNER
Credential: MSPT
Phone: 828-230-2543