MEDICARE: IN FORM HEALTHCARE, INC

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	261QR0400X	Rehabilitation Clinic/Center	346641	NC

General Provider Information

NPI Number	:	1487663654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN FORM HEALTHCARE, INC

Provider Business Mailing Address
First Line	:	403 E PARKWAY
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1652
Country	:	US
Telephone Number	:	336-317-9233
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 PARKWAY
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1652
Country	:	US
Telephone Number	:	336-317-9233
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ASHU CHOPRA
Credential	:
Telephone Number	:	336-761-5066

Provider Enumeration Date	:	08/06/2006
Last Update Date	:	08/22/2020

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