Healthcare Provider Details

I. General information

NPI: 1831395953
Provider Name (Legal Business Name): JONAS ROJAS TAN LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PURDUE DR
FAYETTEVILLE NC
28304-3674
US

IV. Provider business mailing address

PO BOX 36212
FAYETTEVILLE NC
28303-1212
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-5000
  • Fax:
Mailing address:
  • Phone: 910-322-5391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2822
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: