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General NPI Number Information
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NPI Number | 1376953794
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTHCARE SERVICES, INC.
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 2201 S LEMAY AVE
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City | FORT COLLINS
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State | CO
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Zip | 80525-1900
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Country | US
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Telephone | 919-424-5080
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Fax |
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Provider Business Mailing Address
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Address Line | 110 HORIZON DR STE 310
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City | RALEIGH
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State | NC
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Zip | 27615-4926
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Country | US
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Telephone | 919-424-5080
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. WILLIAM GIL WILSON JR.
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Credential |
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Telephone | 919-424-5080
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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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