Provider Demographics
NPI:1043922891
Name:ACTIVE FORCE PHYSICAL THERAPY AND PERFORMANCE
Entity Type:Organization
Organization Name:ACTIVE FORCE PHYSICAL THERAPY AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROWLAND
Authorized Official - Middle Name:NAROND
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-273-2991
Mailing Address - Street 1:439 WESTWOOD SHOPPING CTR # 6
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1532
Mailing Address - Country:US
Mailing Address - Phone:910-273-2991
Mailing Address - Fax:910-679-0181
Practice Address - Street 1:5675 JUNEBERRY LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4860
Practice Address - Country:US
Practice Address - Phone:910-273-2991
Practice Address - Fax:910-679-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health