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General NPI Number Information
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NPI Number | 1114736162
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Entity Type | Organization
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Legal Business Name | FORGED PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/04/2025
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Last Update Date | 01/04/2025
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Provider Practice Location Address
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Address Line | 1372 N MAIN ST
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-2617
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Country | US
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Telephone | 336-686-9822
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Fax |
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Provider Business Mailing Address
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Address Line | 71 CARDONA CT
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-5284
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | JORDAN GARNER PITTMAN
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Credential | DPT
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Telephone | 336-686-9822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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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 | 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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