Provider Demographics
NPI:1144406539
Name:PHYSICAL THERAPY FOR WOMEN, INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY FOR WOMEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:910-798-2318
Mailing Address - Street 1:5919 OLEANDER DR
Mailing Address - Street 2:SUITE 123
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4780
Mailing Address - Country:US
Mailing Address - Phone:910-798-2318
Mailing Address - Fax:910-798-2319
Practice Address - Street 1:1630 MILITARY CUTOFF RD STE 110
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5719
Practice Address - Country:US
Practice Address - Phone:910-798-2318
Practice Address - Fax:910-798-2319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211054Medicaid
NC017WJOtherBLUE CROSS BLUE SHIELD
NC2320258OtherHUMANA
NC2320258OtherHUMANA