Healthcare Provider Details

I. General information

NPI: 1962589838
Provider Name (Legal Business Name): REHAB PROVIDER NETWORK EAST II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 WAKE FOREST RD
RALEIGH NC
27609-6842
US

IV. Provider business mailing address

4009 WAKE FOREST RD
RALEIGH NC
27609-6842
US

V. Phone/Fax

Practice location:
  • Phone: 919-878-9996
  • Fax: 919-878-8871
Mailing address:
  • Phone: 919-878-9996
  • Fax: 919-878-8871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL E. TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-1100