Healthcare Provider Details

I. General information

NPI: 1679378970
Provider Name (Legal Business Name): DANICA FJELSTUL ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 N CENTENNIAL ST
HIGH POINT NC
27262-7602
US

IV. Provider business mailing address

4515 PREMIER DR STE 201
HIGH POINT NC
27265-8356
US

V. Phone/Fax

Practice location:
  • Phone: 336-884-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberLAT-5903
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: