Provider Demographics
NPI:1013539402
Name:PHYSIOFIT OF NORTH CAROLINA
Entity Type:Organization
Organization Name:PHYSIOFIT OF NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST AND CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRISON
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:919-728-0335
Mailing Address - Street 1:12343 WAKE UNION CHURCH RD STE 204
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7434
Mailing Address - Country:US
Mailing Address - Phone:919-728-0335
Mailing Address - Fax:
Practice Address - Street 1:12335 WAKE UNION CHURCH RD STE 204
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4527
Practice Address - Country:US
Practice Address - Phone:919-738-0335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy