Healthcare Provider Details

I. General information

NPI: 1497749352
Provider Name (Legal Business Name): YANCEY CENTER FOR PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W US HIGHWAY 19E
BURNSVILLE NC
28714-8602
US

IV. Provider business mailing address

1720 W US HIGHWAY 19E
BURNSVILLE NC
28714-8602
US

V. Phone/Fax

Practice location:
  • Phone: 828-682-1500
  • Fax: 828-682-1505
Mailing address:
  • Phone: 828-682-1500
  • Fax: 828-682-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number4787
License Number StateNC

VIII. Authorized Official

Name: MR. JOHN RAYMOND MEDINA
Title or Position: DIRECTOR OF PHYSICAL THERAPY
Credential: P.T.
Phone: 828-682-1500