Healthcare Provider Details

I. General information

NPI: 1164638847
Provider Name (Legal Business Name): TONY LAMONT CURRY RKT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 RAMSEY ST
FAYETTEVILLE NC
28301-3856
US

IV. Provider business mailing address

7759 DRAGONHEAD RD
FAYETTEVILLE NC
28311-9212
US

V. Phone/Fax

Practice location:
  • Phone: 910-822-7150
  • Fax: 910-822-7910
Mailing address:
  • Phone: 910-822-7150
  • Fax: 910-822-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1596
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: