Organization
GRIDIRON247
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRIS MCPHAIL (MANAGER)
(910) 525-3088
Entity
Organization
Contact information
Practice address
210 W MARTIN L. KING BLVD, ROSEBORO, NC 28382-9066
(910) 525-3088
Mailing address
210 W MARTIN LUTHER KING BLVD, ROSEBORO, NC 28382-9066
(910) 525-3088
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
12/30/2014
Last updated
12/30/2014
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