Healthcare Provider Details

I. General information

NPI: 1154835296
Provider Name (Legal Business Name): JANICE MINNICH FITCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ERWIN RD
DURHAM NC
27705-4504
US

IV. Provider business mailing address

3000 ERWIN RD
DURHAM NC
27705-4504
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-2846
  • Fax: 919-681-7574
Mailing address:
  • Phone: 919-684-2846
  • Fax: 919-681-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number0742
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: