Vanessa Trevathan

Primary specialty

Orthotic FitterTaxonomy code 225000000X

Practice address

124 W Crescent Square Dr
Graham, NC 27253-4014

Phone

(336) 227-0730

Fax

(336) 227-0732

NPI assigned

Aug 28, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Seniors Medical Supply

  • Durable Medical Equipment & Medical Supplies
  • Graham, NC
  • NPI 1821432295

  Prosthetic/Orthotic Supplier

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1235539016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 W ELM ST",
            "city": "GRAHAM",
            "state": "NC",
            "postal_code": "272532158",
            "telephone_number": "336-227-0730",
            "fax_number": "336-227-0732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 W CRESCENT SQUARE DR",
            "city": "GRAHAM",
            "state": "NC",
            "postal_code": "272534014",
            "telephone_number": "336-227-0730",
            "fax_number": "336-227-0732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREVATHAN",
        "first_name": "VANESSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-28",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225000000X",
            "taxonomy_group": "",
            "desc": "Orthotic Fitter",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7704282",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• TNT Transformation Home LLC
• Angela M Toney
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• Tranquility
• Nakesha Shanay Travis
• Julia Hall Turner, PHARMD
• United Care Center
• Unlimited Restarts Fitness LLC
• Esther Van Zyl, COTA/L
• Vanessa Coble

• Orthotic Fitter in Graham, NC
• Providers in Graham, NC by specialty
• Orthotic Fitter in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.