Basic Information
| Provider Information | |||||||||
| NPI: | 1659379261 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRUECARE PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3214 CHARLES B ROOT WYND | ||||||||
| Address2: | SUITE #155 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276125440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197807740 | ||||||||
| FaxNumber: | 9197807743 | ||||||||
| Practice Location | |||||||||
| Address1: | 3214 CHARLES B ROOT WYND | ||||||||
| Address2: | 214 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276125440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197817740 | ||||||||
| FaxNumber: | 9197817743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 09/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | RADWAN | ||||||||
| AuthorizedOfficialFirstName: | HAMDY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9197817740 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PT, PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8011 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7211499 | 05 | NC | MEDICAID | P00116234 | 01 | NC | RAILROAD MEDICARE | OTHER |