Healthcare Provider Details

I. General information

NPI: 1902511736
Provider Name (Legal Business Name): MANGRUM HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 US HIGHWAY 70 W STE 102
EFLAND NC
27243-8466
US

IV. Provider business mailing address

3419 US HIGHWAY 70 W STE 102
EFLAND NC
27243-8466
US

V. Phone/Fax

Practice location:
  • Phone: 336-792-4881
  • Fax: 877-339-9413
Mailing address:
  • Phone: 336-792-4881
  • Fax: 877-339-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADIO MANGRUM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 336-380-4480