Healthcare Provider Details

I. General information

NPI: 1841755444
Provider Name (Legal Business Name): ADAM KENNETH RECKENBEIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E ARLINGTON BLVD
GREENVILLE NC
27858-5870
US

IV. Provider business mailing address

1540 E ARLINGTON BLVD
GREENVILLE NC
27858-5870
US

V. Phone/Fax

Practice location:
  • Phone: 252-364-2806
  • Fax: 252-364-2863
Mailing address:
  • Phone: 252-364-2806
  • Fax: 252-364-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberP18588
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: