=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447828868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRAKE NEUROMUSCULAR THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2021
-----------------------------------------------------
Last Update Date | 06/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4001 CAMPUS RIDGE RD
-----------------------------------------------------
City | MATTHEWS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28105-5009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-491-1963
-----------------------------------------------------
Fax | 704-821-4883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3939 CAMPUS RIDGE RD
-----------------------------------------------------
City | MATTHEWS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28105-1748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-491-1963
-----------------------------------------------------
Fax | 704-821-4883
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. CHERYL LEIGH DRAKE-BOWERS
-----------------------------------------------------
Credential | LMBT, CAMT
-----------------------------------------------------
Telephone | 704-491-1963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------