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General NPI Number Information
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NPI Number | 1770577397
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Entity Type | Individual
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Provider Name | JOHN RAYMOND MEDINA P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 1720 W US HIGHWAY 19E
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City | BURNSVILLE
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State | NC
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Zip | 28714-8602
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Country | US
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Telephone | 828-682-1500
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Fax | 828-682-1505
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Provider Business Mailing Address
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Address Line | PO BOX 1358
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City | BURNSVILLE
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State | NC
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Zip | 28714-1358
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Country | US
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Telephone | 828-682-1500
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Fax | 828-682-1505
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4787
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License Number State | NC
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