Provider Demographics
NPI:1497749352
Name:YANCEY CENTER FOR PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:YANCEY CENTER FOR PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:828-682-1500
Mailing Address - Street 1:1720 W US HIGHWAY 19E
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-8602
Mailing Address - Country:US
Mailing Address - Phone:828-682-1500
Mailing Address - Fax:828-682-1505
Practice Address - Street 1:1720 W US HIGHWAY 19E
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-8602
Practice Address - Country:US
Practice Address - Phone:828-682-1500
Practice Address - Fax:828-682-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4787261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC58457OtherBLUE CROSS BLUE SHIELD
NY350866700OtherUS DEPT OF LABOR
NC64-00006OtherUNITED HEALTHCARE
NC65002114OtherMEDICARE RAILROAD
NCA4150OtherMEDCOST
NC7210872Medicaid
NC58457OtherBLUE CROSS BLUE SHIELD