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General NPI Number Information
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NPI Number | 1053598920
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Entity Type | Organization
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Legal Business Name | FOUNDATION HEALTH SYSTEMS CORP
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 216 MOORE RD DBA EDWIN H. MARTINAT OUTPT COMP REHAB CTR -KING
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City | KING
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State | NC
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Zip | 27021-8703
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Country | US
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Telephone | 336-719-6165
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 FRONTIS PLAZA BLVD STE 102 NOVANT MEDICAL GROUP
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City | WINSTON SALEM
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State | NC
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Zip | 27103-5616
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Country | US
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Telephone | 336-277-2435
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Fax | 336-277-9275
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Authorized Official
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Title or Position | EXE. VP & CEO & ADMIN
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Name | SALLYE LINER
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Credential |
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Telephone | 336-718-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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