MEDICARE: MR. HORACE VERNON PIGFORD III PT

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	225100000X	Physical Therapist	12005	NC

General Provider Information

NPI Number	:	1043449267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HORACE VERNON PIGFORD III PT

Provider Business Mailing Address
First Line	:	PO BOX 70
Second Line	:
City	:	WALLACE
State	:	NC
Zip	:	28466-0070
Country	:	US
Telephone Number	:	910-285-7388
Fax Number	:	910-285-9149

Provider Business Practice Location Address
First Line	:	112 MEDICAL VILLAGE DR STE B
Second Line	:
City	:	WALLACE
State	:	NC
Zip	:	28466-1665
Country	:	US
Telephone Number	:	910-285-7388
Fax Number	:	910-285-9149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	10/05/2012

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