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General NPI Number Information
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NPI Number | 1730698556
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Entity Type | Organization
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Legal Business Name | CRYOWELL PHYSICAL THERAPY
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 09/25/2017
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Provider Practice Location Address
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Address Line | 37 BRENDAN WAY
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City | GREENVILLE
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State | SC
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Zip | 29615-3514
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Country | US
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Telephone | 687-866-3646
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Fax | 888-651-5324
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Provider Business Mailing Address
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Address Line | 3842 MOURNING DOVE DR
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City | WEDDINGTON
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State | NC
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Zip | 28104-8636
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Country | US
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Telephone | 404-308-0981
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DWIGHT ALEXANDER PEEPLES JR.
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Credential |
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Telephone | 404-320-0981
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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 | 8180
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License Number State | SC
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