1174999882 NPI number — HEATHER N TRIPLETT PTA

Table of content: HEATHER N TRIPLETT PTA (NPI 1174999882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174999882 NPI number — HEATHER N TRIPLETT PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIPLETT
Provider First Name:
HEATHER
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174999882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
290 N HIGHWAY 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28037-8011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-483-0777
Provider Business Mailing Address Fax Number:
704-483-1883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 N HIGHWAY 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28037-8011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-483-0777
Provider Business Practice Location Address Fax Number:
704-483-1883
Provider Enumeration Date:
08/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  A5723 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A5723 . This is a "PHYSICAL THERAPIST ASSISTANT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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