Provider Demographics
NPI:1376164988
Name:AGE WELL NC LLC
Entity Type:Organization
Organization Name:AGE WELL NC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-507-8219
Mailing Address - Street 1:1610 DUNN PL
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-7721
Mailing Address - Country:US
Mailing Address - Phone:908-507-8219
Mailing Address - Fax:
Practice Address - Street 1:1610 DUNN PL
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-7721
Practice Address - Country:US
Practice Address - Phone:908-507-8219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty