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General NPI Number Information
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NPI Number | 1639731136
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Entity Type | Organization
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Legal Business Name | PHOENIX PHYSICAL THERAPY & WELLNESS CENTER, INC
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 500 BENSON RD STE 114
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City | GARNER
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State | NC
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Zip | 27529-3947
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Country | US
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Telephone | 919-323-8888
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Fax | 855-554-1184
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Provider Business Mailing Address
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Address Line | 705 KEYSTONE PARK DR UNIT 22
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City | MORRISVILLE
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State | NC
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Zip | 27560-6101
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Country | US
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Telephone | 919-410-7312
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. ANGEL BALLENTINE
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Credential | PT
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Telephone | 919-410-7312
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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 |
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