MEDICARE: PHYSIOFIT OF NORTH CAROLINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1013539402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSIOFIT OF NORTH CAROLINA

Provider Business Mailing Address
First Line	:	12343 WAKE UNION CHURCH RD STE 204
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-7434
Country	:	US
Telephone Number	:	919-728-0335
Fax Number	:

Provider Business Practice Location Address
First Line	:	12335 WAKE UNION CHURCH RD STE 204
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4527
Country	:	US
Telephone Number	:	919-738-0335
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST AND CO-OWNER
Name	:	DR. HARRISON VAUGHAN
Credential	:	DPT
Telephone Number	:	919-728-0335

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	05/08/2020

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Directions to “PHYSIOFIT OF NORTH CAROLINA ” Practice Location

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