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General NPI Number Information
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NPI Number | 1679865851
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Entity Type | Organization
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Legal Business Name | VITAL ENERGY REHAB NC LLC
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 9007 MAGNA LN
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-5216
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Country | US
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Telephone | 704-698-2104
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Fax |
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Provider Business Mailing Address
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Address Line | 121 CLEARVIEW DR
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City | COLUMBIA
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State | SC
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Zip | 29212-8304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWENER
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Name | HIMA N DALAL
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Credential | OT
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Telephone | 803-359-1551
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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 | 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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