Provider Demographics
NPI:1356405005
Name:PISGAH PHYSICAL THERAPY & SPORTS REHAB, INC
Entity type:Organization
Organization Name:PISGAH PHYSICAL THERAPY & SPORTS REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:VESS
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-693-8128
Mailing Address - Street 1:1635 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-2305
Mailing Address - Country:US
Mailing Address - Phone:182-869-3812
Mailing Address - Fax:828-693-0955
Practice Address - Street 1:1635 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-2305
Practice Address - Country:US
Practice Address - Phone:828-693-8128
Practice Address - Fax:828-693-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211138Medicaid
NC2503325OtherPTAN
NC2503325OtherPTAN