Provider Demographics
NPI:1265852438
Name:ENCORE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ENCORE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, WCS
Authorized Official - Phone:252-354-6978
Mailing Address - Street 1:101 VFW RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:CEDAR POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8269
Mailing Address - Country:US
Mailing Address - Phone:252-354-6978
Mailing Address - Fax:866-472-4761
Practice Address - Street 1:101 VFW RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8269
Practice Address - Country:US
Practice Address - Phone:252-354-6978
Practice Address - Fax:866-472-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12969261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy