Provider Demographics
NPI:1477563062
Name:FOREHAND, JACK WAYNE (PT)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:WAYNE
Last Name:FOREHAND
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 16518
Mailing Address - Street 2:TOUCH THERAPY
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28816-0518
Mailing Address - Country:US
Mailing Address - Phone:828-665-0442
Mailing Address - Fax:828-665-0412
Practice Address - Street 1:1025 BREVARD RD
Practice Address - Street 2:SUITE # 3 TOUCH THERAPY
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-8562
Practice Address - Country:US
Practice Address - Phone:828-665-0442
Practice Address - Fax:828-665-0412
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC7727225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2336574Medicare ID - Type Unspecified