| Valley Physical Medicine Pa | |
|
3706 Morganton Rd Fayetteville NC 28303-4963 | |
| (910) 867-5500 | |
| (910) 867-4120 |
| Full Name | Valley Physical Medicine Pa |
|---|---|
| Speciality | General Practice |
| Location | 3706 Morganton Rd, Fayetteville, North Carolina |
| Authorized Official Name and Position | Brandt Wood (OWNER) |
| Authorized Official Contact | 9108675500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Valley Physical Medicine Pa 3706 Morganton Rd Fayetteville NC 28303-4963 Ph: (910) 867-5500 | Valley Physical Medicine Pa 3706 Morganton Rd Fayetteville NC 28303-4963 Ph: (910) 867-5500 |
| NPI Number | 1629428883 |
|---|---|
| Provider Enumeration Date | 06/20/2016 |
| Last Update Date | 09/23/2016 |
| Medicare PECOS PAC ID | 0547554008 |
|---|---|
| Medicare Enrollment ID | O20160805000506 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629428883 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| Provider Name | Brandt Thomas Wood |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1275573453 PECOS PAC ID: 6305808924 Enrollment ID: I20041027000302 |
| Provider Name | Daniel J Culliton |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1053409649 PECOS PAC ID: 7214030337 Enrollment ID: I20070310000041 |
| Provider Name | Domenico Mancini |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1730288820 PECOS PAC ID: 7416250444 Enrollment ID: I20160125001586 |
| Provider Name | Dawn M Ruminski |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1710120316 PECOS PAC ID: 1658706916 Enrollment ID: I20200114001878 |
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