Provider Demographics
NPI:1982833828
Name:MIGHTY US THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:MIGHTY US THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENYATTA
Authorized Official - Middle Name:VONTRICE
Authorized Official - Last Name:SANDERS-BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-805-0302
Mailing Address - Street 1:7001 SWEETFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7750
Mailing Address - Country:US
Mailing Address - Phone:704-805-0302
Mailing Address - Fax:
Practice Address - Street 1:7001 SWEETFIELD DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7750
Practice Address - Country:US
Practice Address - Phone:704-805-0302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care