Healthcare Provider Details

I. General information

NPI: 1013106624
Provider Name (Legal Business Name): PHYTCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 US HIGHWAY 70 W
GARNER NC
27529-2541
US

IV. Provider business mailing address

PO BOX 41008
FAYETTEVILLE NC
28309-1008
US

V. Phone/Fax

Practice location:
  • Phone: 919-779-5010
  • Fax: 919-771-1640
Mailing address:
  • Phone: 800-849-5609
  • Fax: 910-864-9762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAUREL STOIMENOFF
Title or Position: PRESIDENT
Credential:
Phone: 480-924-8382