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General NPI Number Information
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NPI Number | 1942821681
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Entity Type | Organization
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Legal Business Name | MISSION PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 155 ALLISON PAGE ROAD SUITE B
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City | ABERDEEN
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State | NC
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Zip | 28315
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Country | US
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Telephone | 910-221-9194
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Fax |
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Provider Business Mailing Address
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Address Line | 10205 US HWY 15-501 UNIT 26 #173
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-4301
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Country | US
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Telephone | 315-783-6954
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICAL THERAPIST
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Name | BROOKE B WILTSHIRE
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Credential | DPT
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Telephone | 315-783-6954
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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 |
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License Number State |
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