Healthcare Provider Details

I. General information

NPI: 1003266446
Provider Name (Legal Business Name): PHYSICAL REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 LAKE ADGER RD
MILL SPRING NC
28756-5830
US

IV. Provider business mailing address

3108 LAKE ADGER RD
MILL SPRING NC
28756-5830
US

V. Phone/Fax

Practice location:
  • Phone: 828-625-0400
  • Fax: 828-625-0740
Mailing address:
  • Phone: 828-625-0400
  • Fax: 828-625-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP4217
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP4217
License Number StateNC

VIII. Authorized Official

Name: ROBIN SHEPARD
Title or Position: OWNER
Credential: MSPT
Phone: 828-606-6683