Provider Demographics
NPI:1467677229
Name:PIGFORDS PHYSICAL THERAPY ASSOC INC
Entity Type:Organization
Organization Name:PIGFORDS PHYSICAL THERAPY ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:PIGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:910-285-7388
Mailing Address - Street 1:112 E MEDICAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466
Mailing Address - Country:US
Mailing Address - Phone:910-285-7388
Mailing Address - Fax:910-285-9149
Practice Address - Street 1:112 E MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466
Practice Address - Country:US
Practice Address - Phone:910-285-7388
Practice Address - Fax:910-285-9149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210205Medicaid
NC7210205Medicaid