Basic Information
| Provider Information | |||||||||
| NPI: | 1851318547 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL THERAPY FOR WOMEN'S HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 213 CANDLEWOOD RD | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278042109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524517894 | ||||||||
| FaxNumber: | 2524518894 | ||||||||
| Practice Location | |||||||||
| Address1: | 213 CANDLEWOOD RD | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278042109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524517894 | ||||||||
| FaxNumber: | 2524518894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUNTER | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | BUTNER | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2524517894 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 898 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 079YX | 01 | NC | BCBS | OTHER |