Provider Demographics
NPI:1699450270
Name:PYNOKUL THERAPEUTIC AND DEVELOPMENTAL SERVICES, LLC
Entity type:Organization
Organization Name:PYNOKUL THERAPEUTIC AND DEVELOPMENTAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FATIMAH
Authorized Official - Middle Name:Z
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS, MS ABA
Authorized Official - Phone:910-682-7354
Mailing Address - Street 1:8712 TIN LIZZA DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-8452
Mailing Address - Country:US
Mailing Address - Phone:910-682-7354
Mailing Address - Fax:
Practice Address - Street 1:8712 TIN LIZZA DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-8452
Practice Address - Country:US
Practice Address - Phone:910-682-7354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No273Y00000XHospital UnitsRehabilitation Unit