Provider Demographics
NPI:1689299166
Name:THRESHOLD THERAPEUTIC, LLC
Entity Type:Organization
Organization Name:THRESHOLD THERAPEUTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:980-288-5331
Mailing Address - Street 1:9216 HUNTING CT
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6598
Mailing Address - Country:US
Mailing Address - Phone:980-288-5331
Mailing Address - Fax:980-236-0456
Practice Address - Street 1:6201 FAIRVIEW RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3297
Practice Address - Country:US
Practice Address - Phone:980-288-5331
Practice Address - Fax:980-236-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty