Healthcare Provider Details

I. General information

NPI: 1093916538
Provider Name (Legal Business Name): VILLAGE HEALTH & FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 BROAD ST
ORIENTAL NC
28571-0894
US

IV. Provider business mailing address

PO BOX 894
ORIENTAL NC
28571-0894
US

V. Phone/Fax

Practice location:
  • Phone: 252-249-1051
  • Fax: 252-249-0112
Mailing address:
  • Phone: 252-249-1051
  • Fax: 252-249-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number8706
License Number StateNC

VIII. Authorized Official

Name: MRS. JAN POWERS LAGUARDIA
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 252-249-1051