Provider Demographics
NPI:1700446770
Name:WEAVERVILLE PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:WEAVERVILLE PHYSICAL THERAPY AND WELLNESS
Other - Org Name:BIG IVY PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TRAIL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:828-675-6875
Mailing Address - Street 1:7 GARRISON ROAD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787
Mailing Address - Country:US
Mailing Address - Phone:828-675-6875
Mailing Address - Fax:828-658-5040
Practice Address - Street 1:7 GARRISON ROAD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9215
Practice Address - Country:US
Practice Address - Phone:828-675-6875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation