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General NPI Number Information
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NPI Number | 1366782500
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Entity Type | Organization
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Legal Business Name | THEUNISSE PT INC
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 8832 BLAKENEY PROFESSIONAL DR STE. 100
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City | CHARLOTTE
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State | NC
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Zip | 28277-6809
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Country | US
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Telephone | 704-817-6718
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Fax | 704-817-7887
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Provider Business Mailing Address
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Address Line | 8000 BRIDGER PT
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City | WAXHAW
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State | NC
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Zip | 28173-7243
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Country | US
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Telephone | 704-425-3300
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Fax | 704-817-7887
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LAURA ANNE THEUNISSE
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Credential | PT
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Telephone | 704-425-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P10953
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License Number State | NC
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