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General NPI Number Information
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NPI Number | 1780045419
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Entity Type | Organization
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Legal Business Name | ELMORE CENTER FOR PHYSICAL THERAPY AND LYMPHEDEMA SERVICES
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 7417 KNIGHTDALE BLVD SUITE#103
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City | KNIGHTDALE
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State | NC
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Zip | 27545-8824
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Country | US
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Telephone | 919-217-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 15 FLOWERING APRICOT DR
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City | DURHAM
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State | NC
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Zip | 27703-6362
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Country | US
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Telephone | 919-885-9135
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BROOKE MIRANDA ELMORE
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Credential | DPT
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Telephone | 919-885-9135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | P14582
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License Number State | NC
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