MEDICARE: ACHIEVABLE THERAPEUTIC INTERVENTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	NC
2	251S00000X	Community/Behavioral Health Agency	NC
3	252Y00000X	Early Intervention Provider Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548484546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACHIEVABLE THERAPEUTIC INTERVENTIONS

Provider Business Mailing Address
First Line	:	109 SMART CT
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-1849
Country	:	US
Telephone Number	:	919-412-7502
Fax Number	:	919-231-2219

Provider Business Practice Location Address
First Line	:	5421 OLD POOLE RD STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-3285
Country	:	US
Telephone Number	:	919-231-2261
Fax Number	:	919-231-2219

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DARRYL POWELL PEEBLES JR.
Credential	:
Telephone Number	:	919-412-7502

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	02/02/2012

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Directions to “ACHIEVABLE THERAPEUTIC INTERVENTIONS ” Practice Location

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