Provider Demographics
NPI:1336182492
Name:SOUTHEASTERN HEALTH AND FITNESS INC
Entity type:Organization
Organization Name:SOUTHEASTERN HEALTH AND FITNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:DECURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:828-664-1134
Mailing Address - Street 1:POST OFFICE BOX 434
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711
Mailing Address - Country:US
Mailing Address - Phone:828-664-1134
Mailing Address - Fax:828-664-9540
Practice Address - Street 1:10 E MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-9310
Practice Address - Country:US
Practice Address - Phone:828-664-1134
Practice Address - Fax:828-664-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1770569824OtherNPI NUMBER
NC1245216399OtherNPI NUMBER
NC1841273042OtherNPI