Organization
PROVIDENCE PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID ALAN DEITZ (OWNER/MANAGER)
(901) 803-2040
Entity
Organization
Contact information
Practice address
107 TRITON LN, SURF CITY, NC 28445-6923
(910) 803-2040
(910) 803-2050
Mailing address
271 HICKORY POINT RD, HAMPSTEAD, NC 28443-2633
(724) 288-1629
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
08/22/2017
Last updated
04/14/2026
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