Healthcare Provider Details

I. General information

NPI: 1962580225
Provider Name (Legal Business Name): PHYSICAL THERAPY RESOURCES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6385 CARATOKE HWY
GRANDY NC
27939-9617
US

IV. Provider business mailing address

6385 CARATOKE HWY
GRANDY NC
27939-9617
US

V. Phone/Fax

Practice location:
  • Phone: 252-457-1090
  • Fax:
Mailing address:
  • Phone: 252-457-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7211764
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: SUSAN B MCGANN
Title or Position: PRESIDENT
Credential: PT, OCS
Phone: 252-457-1090