Provider Demographics
NPI:1063734507
Name:ROANOKE CHOWAN REHAB INC
Entity type:Organization
Organization Name:ROANOKE CHOWAN REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:VICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:252-332-6760
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0576
Mailing Address - Country:US
Mailing Address - Phone:252-332-6760
Mailing Address - Fax:252-332-1688
Practice Address - Street 1:1109 E MEMORIAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3919
Practice Address - Country:US
Practice Address - Phone:252-332-6760
Practice Address - Fax:252-332-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1872261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy