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General NPI Number Information
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NPI Number | 1972269678
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Entity Type | Organization
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Legal Business Name | VITALEE PT
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 12 OLD CHARLOTTE HWY STE 30
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City | ASHEVILLE
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State | NC
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Zip | 28803-9420
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Country | US
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Telephone | 828-774-7391
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Fax |
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Provider Business Mailing Address
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Address Line | 31 HAMPDEN RD
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City | ASHEVILLE
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State | NC
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Zip | 28805-2421
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Country | US
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Telephone | 828-774-7391
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | SAMUEL LEE PATTILLO
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Credential |
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Telephone | 828-774-7391
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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 |
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License Number State |
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