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General NPI Number Information
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NPI Number | 1972383743
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Entity Type | Organization
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Legal Business Name | LONGEVITY PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 217 COXE AVE STE 10
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City | ASHEVILLE
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State | NC
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Zip | 28801-4080
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Country | US
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Telephone | 828-484-1703
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Fax |
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Provider Business Mailing Address
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Address Line | 110 CISCO RD
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City | ASHEVILLE
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State | NC
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Zip | 28805-1311
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | JESSICA O TRIPP
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Credential | DPT
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Telephone | 828-484-1703
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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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