Provider Demographics
NPI:1528290194
Name:IDEAS INVESTED, L.L.C.
Entity type:Organization
Organization Name:IDEAS INVESTED, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TALISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANNERMAN-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:910-789-9568
Mailing Address - Street 1:211 W WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-5331
Mailing Address - Country:US
Mailing Address - Phone:910-789-9568
Mailing Address - Fax:
Practice Address - Street 1:211 W WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5331
Practice Address - Country:US
Practice Address - Phone:910-789-9568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty