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General NPI Number Information
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NPI Number | 1568288447
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Entity Type | Organization
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Legal Business Name | PROACTIVE THERAPY AND WELLNESS
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 6579 LAKE BRANDT RD
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City | SUMMERFIELD
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State | NC
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Zip | 27358-9716
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Country | US
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Telephone | 336-403-9582
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Fax |
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Provider Business Mailing Address
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Address Line | 6579 LAKE BRANDT RD
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City | SUMMERFIELD
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State | NC
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Zip | 27358-9716
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Country | US
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Telephone | 336-403-9582
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MICHELE WALKER
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Credential | PT
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Telephone | 336-403-9582
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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 |
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License Number State |
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