MEDICARE: PHYTCARE LLC

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	208100000X	Physical Medicine & Rehabilitation Physician		NC

General Provider Information

NPI Number	:	1043497589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYTCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 41008
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28309-1008
Country	:	US
Telephone Number	:	800-849-5609
Fax Number	:	910-864-9762

Provider Business Practice Location Address
First Line	:	1911 FALLS VALLEY DRIVE
Second Line	:	SUITE 100
City	:	RALEIGH
State	:	NC
Zip	:	27615-0000
Country	:	US
Telephone Number	:	800-849-5609
Fax Number	:	910-864-9762

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAUREL STOIMENOFF
Credential	:
Telephone Number	:	800-849-5609

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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