Healthcare Provider Details

I. General information

NPI: 1619979226
Provider Name (Legal Business Name): PHYSICIANS TOTAL REHAB OF FAYETTEVILLE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 VILLAGE DR
FAYETTEVILLE NC
28304-3815
US

IV. Provider business mailing address

2930 VILLAGE DR
FAYETTEVILLE NC
28304-3815
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-9010
  • Fax: 910-323-9568
Mailing address:
  • Phone: 910-323-9010
  • Fax: 910-323-9568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number39135
License Number StateNC

VIII. Authorized Official

Name: DR. ZANE T WALSH JR.
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 910-323-9010