Provider Demographics
NPI:1013756642
Name:NEUROGERON PHYSICAL THERAPY AND REHABILITATION, LLC
Entity type:Organization
Organization Name:NEUROGERON PHYSICAL THERAPY AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEMMRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-647-0345
Mailing Address - Street 1:2010 STRATTON HILLS CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2571
Mailing Address - Country:US
Mailing Address - Phone:336-509-9616
Mailing Address - Fax:
Practice Address - Street 1:2010 STRATTON HILLS CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2571
Practice Address - Country:US
Practice Address - Phone:336-509-9616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty