Healthcare Provider Details

I. General information

NPI: 1497085252
Provider Name (Legal Business Name): JCS REHABILITATION & WELLNESS CENTER,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 N SANDHILLS BLVD SUITE B
ABERDEEN NC
28315-2382
US

IV. Provider business mailing address

1902 N SANDHILLS BLVD SUITE D
ABERDEEN NC
28315-2382
US

V. Phone/Fax

Practice location:
  • Phone: 910-215-7155
  • Fax: 910-944-5901
Mailing address:
  • Phone: 910-215-7155
  • Fax: 910-944-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7235
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2301
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8637
License Number StateNC

VIII. Authorized Official

Name: JERRY LEE JONES
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MS,CCC-SLP
Phone: 910-215-7155