Healthcare Provider Details

I. General information

NPI: 1013548072
Provider Name (Legal Business Name): HEALTHY SENIORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 CAROLINA BEACH RD STE 100
WILMINGTON NC
28412-2366
US

IV. Provider business mailing address

4829 CAROLINA BEACH RD STE 100
WILMINGTON NC
28412-2366
US

V. Phone/Fax

Practice location:
  • Phone: 910-444-0020
  • Fax:
Mailing address:
  • Phone: 910-444-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROSS TERRY
Title or Position: OWNER
Credential: DPT
Phone: 731-845-3038