Provider Demographics
NPI:1912439464
Name:MICAH GREGORY MERRITT
Entity Type:Organization
Organization Name:MICAH GREGORY MERRITT
Other - Org Name:RENEW HEALTH AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, CERT MDT
Authorized Official - Phone:910-207-6696
Mailing Address - Street 1:812 PINCKNEY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3308
Mailing Address - Country:US
Mailing Address - Phone:910-207-6696
Mailing Address - Fax:910-207-6773
Practice Address - Street 1:812 PINCKNEY ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3308
Practice Address - Country:US
Practice Address - Phone:910-207-6696
Practice Address - Fax:910-207-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty