Healthcare Provider Details

I. General information

NPI: 1821389875
Provider Name (Legal Business Name): WAR EAGLE REHABILITATIVE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 PARKVIEW LN
ADVANCE NC
27006-8777
US

IV. Provider business mailing address

PO BOX 2091
ADVANCE NC
27006-2091
US

V. Phone/Fax

Practice location:
  • Phone: 336-940-2702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: KEVIN D MULLIS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 336-940-2702