Provider Demographics
NPI:1518226448
Name:THERACCESS
Entity Type:Organization
Organization Name:THERACCESS
Other - Org Name:VASTACCESS, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHMUKH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, OTR/L, CPC,
Authorized Official - Phone:919-421-4263
Mailing Address - Street 1:1101 PEMBERTON HILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3957
Mailing Address - Country:US
Mailing Address - Phone:919-421-4263
Mailing Address - Fax:
Practice Address - Street 1:1101 PEMBERTON HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3957
Practice Address - Country:US
Practice Address - Phone:919-421-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-12
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6766225X00000X
NC89261QP2000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation