Organization
ACTIVEDGE FITNESS AND SPORTS PERFORMANCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN DAVID DIAZ MPT (OWNER)
(919) 493-1204
Entity
Organization
Contact information
Practice address
4221 GARRETT RD, SUITE 1-2, DURHAM, NC 27707-3467
(919) 493-1204
(919) 493-1204
Mailing address
4221 GARRETT RD, SUITE 1-2, DURHAM, NC 27707-3467
(919) 493-1204
(919) 493-1204
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
8453
NC
Other
Enumeration date
09/20/2013
Last updated
09/20/2013
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