Provider Demographics
NPI:1437399979
Name:INSIDEOUT BODY THERAPIES, LLC
Entity Type:Organization
Organization Name:INSIDEOUT BODY THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MISCHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:919-361-0104
Mailing Address - Street 1:5720 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9089
Mailing Address - Country:US
Mailing Address - Phone:919-361-0104
Mailing Address - Fax:919-361-0105
Practice Address - Street 1:5720 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9089
Practice Address - Country:US
Practice Address - Phone:919-361-0104
Practice Address - Fax:919-361-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97152251X0800X
NC95672251X0800X
NC102102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty