Organization
WAKE SPECIALTY PHYSICIANS LLC
Active
Other names
WakeMed Physician Practices Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (CHIEF FINANCIAL OFFICER)
(919) 350-6089
Entity
Organization
Contact information
Practice address
10010 FALLS OF NEUSE RD, SUITE 009, RALEIGH, NC 27614-8495
(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
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7108950010
DME PTAN
NC
Enumeration date
02/17/2016
Last updated
05/19/2016
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