=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811697246
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESURGENCE PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2023
-----------------------------------------------------
Last Update Date | 03/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 SOUTHSIDE VILLAGE DR
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-8679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-552-4647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 SOUTHSIDE VILLAGE DR
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-8679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-552-4647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. JONATHAN MICHAEL FRAKES
-----------------------------------------------------
Credential | PT, DPT, CSCS
-----------------------------------------------------
Telephone | 828-552-4647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------