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General NPI Number Information
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NPI Number | 1699450270
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Entity Type | Organization
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Legal Business Name | PYNOKUL THERAPEUTIC AND DEVELOPMENTAL SERVICES, LLC
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 8712 TIN LIZZA DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-8452
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Country | US
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Telephone | 910-682-7354
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Fax |
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Provider Business Mailing Address
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Address Line | 8712 TIN LIZZA DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-8452
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Country | US
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Telephone | 910-682-7354
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | FATIMAH Z WEBB
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Credential | LCAS, MS ABA
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Telephone | 910-682-7354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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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 | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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