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Organization
WAKE SPECIALTY PHYSICIANS LLC
Active
Organization
WAKE SPECIALTY PHYSICIANS LLC
Active
Other names
WakeMed Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
10010 FALLS OF NEUSE RD, RALEIGH, NC 27614-8494
(919) 350-1508
(919) 350-1475
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440375
—
NC
Enumeration date
05/14/2015
Last updated
05/21/2015
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