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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1164668075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYTCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 41007
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28309-1007
Country	:	US
Telephone Number	:	800-849-5609
Fax Number	:	910-868-3216

Provider Business Practice Location Address
First Line	:	3500 MOUNT HOLLY HUNTERSVILLE RD
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-8644
Country	:	US
Telephone Number	:	704-399-7800
Fax Number	:	704-399-7717

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAUREL STOIMENOFF
Credential	:
Telephone Number	:	480-924-8382

Provider Enumeration Date	:	12/23/2008
Last Update Date	:	12/23/2008

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Directions to “PHYTCARE LLC ” Practice Location

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