Provider Demographics
NPI:1093424723
Name:DFENDER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:DFENDER PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, MPT, CIDN, CCI, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FENDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:252-678-4065
Mailing Address - Street 1:538 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-2512
Mailing Address - Country:US
Mailing Address - Phone:252-678-4065
Mailing Address - Fax:
Practice Address - Street 1:1205 EAST 10TH STREET
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-678-4065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy