Basic Information
Provider Information | |||||||||
NPI: | 1649297003 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DEPAOLI-DUNN | ||||||||
FirstName: | THERESA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT MS OCS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3701 NW CARY PARKWAY | ||||||||
Address2: | SUITE 301 | ||||||||
City: | CARY | ||||||||
State: | NC | ||||||||
PostalCode: | 27513 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9193880111 | ||||||||
FaxNumber: | 9193888668 | ||||||||
Practice Location | |||||||||
Address1: | 3701 NW CARY PARKWAY | ||||||||
Address2: | SUITE 301 | ||||||||
City: | CARY | ||||||||
State: | NC | ||||||||
PostalCode: | 27513 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9193880111 | ||||||||
FaxNumber: | 9193888668 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/15/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6820 | NC | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 6698159 | 01 | NC | GHI | OTHER | 836260 | 01 | NC | ACN MPN UHC | OTHER | 1139H | 01 | NC | BCBS | OTHER | 2047616 | 01 | NC | AETNA HMO | OTHER | 7210400 | 05 | NC |   | MEDICAID | 5603358 | 01 | NC | AETNA PPO | OTHER | 1349287 | 01 | NC | ACN MPN UHC | OTHER |