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General NPI Number Information
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NPI Number | 1689914590
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Entity Type | Organization
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Legal Business Name | NC PHYSIATRY PLLC
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Dates
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Enumeration Date | 03/01/2013
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 616 WADE AVE
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City | RALEIGH
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State | NC
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Zip | 27605-1237
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Country | US
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Telephone | 919-828-6251
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Fax | 919-828-3294
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Provider Business Mailing Address
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Address Line | 1409 CRIMSON CREEK DR
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City | DURHAM
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State | NC
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Zip | 27713-8219
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Country | US
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Telephone | 919-452-4691
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | BROOKE GARTRELL MORGAN
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Credential | MD
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Telephone | 919-452-4691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2012-00835
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License Number State | NC
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