Provider Demographics
NPI:1730555202
Name:SALEM PHYSICAL THERAPY AND SPORTS REHAB
Entity type:Organization
Organization Name:SALEM PHYSICAL THERAPY AND SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-782-1971
Mailing Address - Street 1:3098 HEALY DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1432
Mailing Address - Country:US
Mailing Address - Phone:336-782-1971
Mailing Address - Fax:336-448-2004
Practice Address - Street 1:3098 HEALY DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1432
Practice Address - Country:US
Practice Address - Phone:336-782-1971
Practice Address - Fax:336-448-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP8890283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital