Provider Demographics
NPI:1407115116
Name:WAKE ORTHOPAEDICS, LLC
Entity Type:Organization
Organization Name:WAKE ORTHOPAEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-232-5020
Mailing Address - Street 1:3009 NEW BERN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1214
Mailing Address - Country:US
Mailing Address - Phone:919-232-5020
Mailing Address - Fax:919-232-5021
Practice Address - Street 1:212 ASHVILLE AVE
Practice Address - Street 2:STE 30
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6669
Practice Address - Country:US
Practice Address - Phone:919-235-0616
Practice Address - Fax:919-235-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13373261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy