Healthcare Provider Details

I. General information

NPI: 1356536205
Provider Name (Legal Business Name): JOYCE EQUILS PHELPS LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 INTERNATIONAL PKWY STE 2051
HEATHROW FL
32746-5352
US

IV. Provider business mailing address

391 LAMB RD
ROPER NC
27970-9672
US

V. Phone/Fax

Practice location:
  • Phone: 800-798-6035
  • Fax:
Mailing address:
  • Phone: 252-793-6422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: