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NPI Code Detail

MEDICARE: THRESHOLD THERAPEUTIC, LLC

MEDICARE: THRESHOLD THERAPEUTIC, LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist
2235Z00000XSpeech-Language Pathologist
3225X00000XOccupational Therapist

General Provider Information

NPI Number : 1689299166
Entity Type Code : Organization
Provider Name (Legal Business Name) : THRESHOLD THERAPEUTIC, LLC
Provider Business Mailing Address
First Line : 9216 HUNTING CT
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-6598
Country : US
Telephone Number : 980-288-5331
Fax Number : 980-236-0456
Provider Business Practice Location Address
First Line : 6201 FAIRVIEW RD STE 200
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3297
Country : US
Telephone Number : 980-288-5331
Fax Number : 980-236-0456
Authorized Official
Title or Position : OWNER
Name : MATTIE ABLITZ
Credential : OTR/L
Telephone Number : 980-288-5331
Provider Enumeration Date : 06/10/2020
Last Update Date : 04/27/2022

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Directions to “THRESHOLD THERAPEUTIC, LLC ” Practice Location

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