Provider Demographics
NPI:1174620371
Name:AT HOME THERAPY OF WILMINGTON, INC.
Entity type:Organization
Organization Name:AT HOME THERAPY OF WILMINGTON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:910-509-2810
Mailing Address - Street 1:PO BOX 3365
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-0365
Mailing Address - Country:US
Mailing Address - Phone:910-509-2810
Mailing Address - Fax:910-256-8560
Practice Address - Street 1:530 CAUSEWAY DR
Practice Address - Street 2:SUITE B-3
Practice Address - City:WRIGHTSVILLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28480-1959
Practice Address - Country:US
Practice Address - Phone:910-509-2810
Practice Address - Fax:910-256-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016NTOtherBCBS OF NORTH CAROLINA
NC7211671Medicaid
NC7211671Medicaid