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General NPI Number Information
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NPI Number | 1689299166
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Entity Type | Organization
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Legal Business Name | THRESHOLD THERAPEUTIC, LLC
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 6201 FAIRVIEW RD STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28210-3297
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Country | US
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Telephone | 980-288-5331
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Fax | 980-236-0456
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Provider Business Mailing Address
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Address Line | 9216 HUNTING CT
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City | MATTHEWS
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State | NC
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Zip | 28105-6598
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Country | US
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Telephone | 980-288-5331
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Fax | 980-236-0456
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Authorized Official
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Title or Position | OWNER
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Name | MATTIE ABLITZ
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Credential | OTR/L
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Telephone | 980-288-5331
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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