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General NPI Number Information
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NPI Number | 1184806283
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHYSICAL THERAPY & REHABILITATION, LLC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 825 GUM BRANCH RD SUITE 127
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City | JACKSONVILLE
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State | NC
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Zip | 28540-6298
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Country | US
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Telephone | 910-438-9701
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Fax |
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Provider Business Mailing Address
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Address Line | 825 GUM BRANCH RD SUITE 127
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City | JACKSONVILLE
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State | NC
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Zip | 28540-6298
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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 | OWNER
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Name | DANE A. PERSON
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Credential | DPT
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Telephone | 910-438-9701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 9366
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License Number State | NC
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