Provider Demographics
NPI:1699791129
Name:SOUTHEASTERN PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:SOUTHEASTERN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CADY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:828-274-2188
Mailing Address - Street 1:23 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3152
Mailing Address - Country:US
Mailing Address - Phone:828-274-2188
Mailing Address - Fax:828-274-7843
Practice Address - Street 1:1256 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1905
Practice Address - Country:US
Practice Address - Phone:828-412-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200476Medicaid
NC011X3OtherBCBS GROUP NUMBER
NC650016473OtherRAILROAD MEDICARE GROUP #
NC7200476Medicaid