Provider Demographics
NPI:1366782500
Name:THEUNISSE PT INC
Entity type:Organization
Organization Name:THEUNISSE PT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:THEUNISSE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:704-425-3300
Mailing Address - Street 1:8000 BRIDGER PT
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7243
Mailing Address - Country:US
Mailing Address - Phone:704-425-3300
Mailing Address - Fax:704-817-7887
Practice Address - Street 1:8832 BLAKENEY PROFESSIONAL DR
Practice Address - Street 2:STE. 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6809
Practice Address - Country:US
Practice Address - Phone:704-817-6718
Practice Address - Fax:704-817-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP10953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty