Provider Demographics
NPI:1083795017
Name:IRVIN, FRANK J JR (PT)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:J
Last Name:IRVIN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:IRVIN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2701 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3669
Mailing Address - Country:US
Mailing Address - Phone:336-375-4263
Mailing Address - Fax:336-375-4262
Practice Address - Street 1:1103 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1008
Practice Address - Country:US
Practice Address - Phone:336-275-2285
Practice Address - Fax:336-275-2286
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC250413OtherMEDICARE PHYSICAL THERAPY