MEDICARE: ASCENT PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5925	NC

General Provider Information

NPI Number	:	1649522285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENT PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	4 RIDGE GROVE CT
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-1527
Country	:	US
Telephone Number	:	336-545-1610
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 RIDGE GROVE CT
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-1527
Country	:	US
Telephone Number	:	336-545-1610
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	SMITA PATEL
Credential	:
Telephone Number	:	336-545-1610

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	10/05/2012

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