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General NPI Number Information
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NPI Number | 1265739239
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Entity Type | Organization
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Legal Business Name | DISCOVER THERAPY LLC
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Dates
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Enumeration Date | 02/27/2011
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Last Update Date | 10/28/2013
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Provider Practice Location Address
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Address Line | 6536 BURNSIDE PL
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-2907
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Country | US
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Telephone | 910-583-9471
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Fax | 910-487-3541
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Provider Business Mailing Address
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Address Line | PO BOX 1507
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City | FAYETTEVILLE
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State | NC
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Zip | 28302-1507
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Country | US
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Telephone | 910-583-9471
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Fax | 910-487-3541
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICA MITCHELL
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Credential | PT
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Telephone | 910-583-9471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A773
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License Number State | NC
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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 | P9546
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License Number State | NC
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