Healthcare Provider Details

I. General information

NPI: 1982923686
Provider Name (Legal Business Name): IN HOME PHYSICAL THERAPY AND WELLNESS OF MEBANE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 STONEHAM RD
MEBANE NC
27302-9641
US

IV. Provider business mailing address

119 STONEHAM RD
MEBANE NC
27302-9641
US

V. Phone/Fax

Practice location:
  • Phone: 336-269-8187
  • Fax: 888-705-7429
Mailing address:
  • Phone: 336-269-8187
  • Fax: 888-705-7429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number6225
License Number StateNC

VIII. Authorized Official

Name: MICHAEL PATRICK BYRNES
Title or Position: OWNER
Credential: PHYSICAL THERAPIST
Phone: 336-269-8187