MEDICARE: OAK RIDGE PHYSICAL THERAPY, 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	225100000X	Physical Therapist	3679	NC

General Provider Information

NPI Number	:	1659527729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK RIDGE PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 875
Second Line	:
City	:	OAK RIDGE
State	:	NC
Zip	:	27310-0875
Country	:	US
Telephone Number	:	336-644-0201
Fax Number	:	336-644-0501

Provider Business Practice Location Address
First Line	:	2205 OAK RIDGE RD
Second Line	:	SUITE FF
City	:	OAK RIDGE
State	:	NC
Zip	:	27310-8728
Country	:	US
Telephone Number	:	336-644-0201
Fax Number	:	336-644-0501

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANDREW D MICHELS
Credential	:	PT
Telephone Number	:	336-644-0201

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	08/10/2008

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