Healthcare Provider Details

I. General information

NPI: 1174620371
Provider Name (Legal Business Name): AT HOME THERAPY OF WILMINGTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 CAUSEWAY DR SUITE B-3
WRIGHTSVILLE BEACH NC
28480-1959
US

IV. Provider business mailing address

PO BOX 3365
WILMINGTON NC
28406-0365
US

V. Phone/Fax

Practice location:
  • Phone: 910-509-2810
  • Fax: 910-256-8560
Mailing address:
  • Phone: 910-509-2810
  • Fax: 910-256-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: GREGORY LEW
Title or Position: PRESIDENT
Credential: P.T.
Phone: 910-509-2810