Provider Demographics
NPI:1154608271
Name:DENALI THERAPEUTICS
Entity type:Organization
Organization Name:DENALI THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:OF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:704-771-9153
Mailing Address - Street 1:1407 SKYLER DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6762
Mailing Address - Country:US
Mailing Address - Phone:704-771-9153
Mailing Address - Fax:704-353-7246
Practice Address - Street 1:1407 SKYLER DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6762
Practice Address - Country:US
Practice Address - Phone:704-771-9153
Practice Address - Fax:704-353-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9608261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy