Healthcare Provider Details

I. General information

NPI: 1053665745
Provider Name (Legal Business Name): JODY ANN MURPHY A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 TURNBERRY WAY
PINEHURST NC
28374-8509
US

IV. Provider business mailing address

13060 MONTCLAIR DR
LAURINBURG NC
28352-2002
US

V. Phone/Fax

Practice location:
  • Phone: 910-725-1708
  • Fax: 910-725-1718
Mailing address:
  • Phone: 910-384-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0930
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: