Organization
TRI-COUNTY SPORTS & REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVAN JOHN ORTA PT, DPT (PT/OWNER)
(336) 258-8252
Entity
Organization
Contact information
Practice address
2015 N BRIDGE ST, ELKIN, NC 28621-2107
(336) 258-8252
(336) 258-8253
Mailing address
2015 N BRIDGE ST, ELKIN, NC 28621-2107
(336) 258-8252
(336) 258-8253
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
P4862
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890281H
—
NC
Enumeration date
11/08/2017
Last updated
11/08/2017
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