Healthcare Provider Details

I. General information

NPI: 1649360686
Provider Name (Legal Business Name): CAWH REHABILITATION SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10116 OLD LIBERTY RD
LIBERTY NC
27298-8072
US

IV. Provider business mailing address

10116 OLD LIBERTY RD PO BOX 486
LIBERTY NC
27298-8072
US

V. Phone/Fax

Practice location:
  • Phone: 336-622-9641
  • Fax: 336-622-9713
Mailing address:
  • Phone: 336-622-9641
  • Fax: 336-622-9713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KIM MARTIN
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 336-622-9641