Healthcare Provider Details

I. General information

NPI: 1356405005
Provider Name (Legal Business Name): PISGAH PHYSICAL THERAPY & SPORTS REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 ASHEVILLE HWY
HENDERSONVILLE NC
28791-2305
US

IV. Provider business mailing address

1635 ASHEVILLE HWY
HENDERSONVILLE NC
28791-2305
US

V. Phone/Fax

Practice location:
  • Phone: 828-693-8128
  • Fax: 828-693-0955
Mailing address:
  • Phone: 182-869-3812
  • Fax: 828-693-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DONNA VESS BRADLEY
Title or Position: BILLING SPECIALIST
Credential:
Phone: 828-693-8128