1659402295 NPI number — FOCHT THERAPY INCORPORATED

Table of content: (NPI 1659402295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659402295 NPI number — FOCHT THERAPY INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOCHT THERAPY INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1659402295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1410 LONAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAXHAW
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28173-6913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-517-8279
Provider Business Mailing Address Fax Number:
704-243-0749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1410 LONAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAXHAW
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28173-6913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-517-8279
Provider Business Practice Location Address Fax Number:
704-243-0749
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FOCHT
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT PHYSICAL THERAPIST
Authorized Official Telephone Number:
704-517-8279

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  5060 , 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: 7276611 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76611 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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