Provider Demographics
NPI:1407689615
Name:BACCHUS, TASLIMA ELISHA (DPT)
Entity type:Individual
Prefix:
First Name:TASLIMA
Middle Name:ELISHA
Last Name:BACCHUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:906 MEBANE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7951
Mailing Address - Country:US
Mailing Address - Phone:919-563-1133
Mailing Address - Fax:919-563-1833
Practice Address - Street 1:5011 WEDDINGTON RD STE 50
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-9037
Practice Address - Country:US
Practice Address - Phone:980-248-1211
Practice Address - Fax:980-248-1212
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCP23531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist