Provider Demographics
NPI:1710184924
Name:PANCHO, JHEFFREY ABRERO (LPT)
Entity Type:Individual
Prefix:MR
First Name:JHEFFREY
Middle Name:ABRERO
Last Name:PANCHO
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 SHERWOOD DR
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5235
Mailing Address - Country:US
Mailing Address - Phone:336-456-8214
Mailing Address - Fax:
Practice Address - Street 1:ANNIE PENN NURSING CENTER
Practice Address - Street 2:618-A SOUTH MAIN STREET
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320
Practice Address - Country:US
Practice Address - Phone:336-951-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist