=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710005210
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN B WADSWORTH PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 HOSPITAL DR SPRUCE PINE HOSPITAL
-----------------------------------------------------
City | SPRUCE PINE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28777-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-765-7901
-----------------------------------------------------
Fax | 828-766-3065
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 943 209 NORTH MITCHELL
-----------------------------------------------------
City | BAKERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28705-0943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-284-0103
-----------------------------------------------------
Fax | 828-766-3065
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 8457
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------