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General NPI Number Information
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NPI Number | 1619979226
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Entity Type | Organization
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Legal Business Name | PHYSICIANS TOTAL REHAB OF FAYETTEVILLE INC.
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 2930 VILLAGE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3815
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Country | US
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Telephone | 910-323-9010
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Fax | 910-323-9568
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Provider Business Mailing Address
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Address Line | 2930 VILLAGE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3815
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Country | US
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Telephone | 910-323-9010
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Fax | 910-323-9568
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ZANE T WALSH JR.
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Credential | MD
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Telephone | 910-323-9010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NC
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 39135
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License Number State | NC
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