Provider Demographics
NPI:1467517227
Name:STOUT THERAPY SERVICES INC
Entity Type:Organization
Organization Name:STOUT THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-380-1935
Mailing Address - Street 1:PO BOX 881
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-0881
Mailing Address - Country:US
Mailing Address - Phone:336-584-5621
Mailing Address - Fax:336-584-5621
Practice Address - Street 1:4203 SOUTH CHURCH STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-260-8469
Practice Address - Fax:336-584-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078KWOtherPROVIDER NUMBER
NC7211244Medicaid
NC2504078Medicare ID - Type Unspecified