Basic Information
| Provider Information | |||||||||
| NPI: | 1003113499 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEGACY HEALTHCARE SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 SE CARY PKWY | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275115682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194609955 | ||||||||
| FaxNumber: | 9194609959 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 SE CARY PKWY | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275115682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194609955 | ||||||||
| FaxNumber: | 9194609959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2011 | ||||||||
| LastUpdateDate: | 02/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | AUGUSTON | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | REHAB DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9194609955 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTR/L,RD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 3796 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.