Healthcare Provider Details

I. General information

NPI: 1760870653
Provider Name (Legal Business Name): ROGER TURNER NC PTA #694
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 SAVANNAH VIEW LN
SYLVA NC
28779-7235
US

IV. Provider business mailing address

748 SAVANNAH VIEW LN
SYLVA NC
28779-7235
US

V. Phone/Fax

Practice location:
  • Phone: 828-586-1508
  • Fax: 603-218-7676
Mailing address:
  • Phone: 828-586-1508
  • Fax: 603-218-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA-694
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberA-694
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: