Healthcare Provider Details

I. General information

NPI: 1982674842
Provider Name (Legal Business Name): MICHAEL JAMES BIRES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W GANNON AVE
ZEBULON NC
27597-2510
US

IV. Provider business mailing address

530 W GANNON AVE
ZEBULON NC
27597-2510
US

V. Phone/Fax

Practice location:
  • Phone: 919-269-0107
  • Fax: 919-269-0207
Mailing address:
  • Phone: 919-269-0107
  • Fax: 919-269-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7748
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: