Provider Demographics
NPI:1093916538
Name:VILLAGE HEALTH & FITNESS
Entity Type:Organization
Organization Name:VILLAGE HEALTH & FITNESS
Other - Org Name:PHYSICAL THERAPY OF ORIENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:POWERS
Authorized Official - Last Name:LAGUARDIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:252-249-1051
Mailing Address - Street 1:PO BOX 894
Mailing Address - Street 2:
Mailing Address - City:ORIENTAL
Mailing Address - State:NC
Mailing Address - Zip Code:28571-0894
Mailing Address - Country:US
Mailing Address - Phone:252-249-1051
Mailing Address - Fax:252-249-0112
Practice Address - Street 1:1006 BROAD ST
Practice Address - Street 2:
Practice Address - City:ORIENTAL
Practice Address - State:NC
Practice Address - Zip Code:28571-0894
Practice Address - Country:US
Practice Address - Phone:252-249-1051
Practice Address - Fax:252-249-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8706261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078JJOtherBLUE CROSS BLUE SHIELD
NC2504009AMedicare ID - Type Unspecified