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Organization

BODYGAMES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DERICK MARCEL COE DPT (PHYSICAL THERAPIST)
(910) 827-3992
Entity
Organization

Contact information

Practice address
3823 GUESS RD, DURHAM, NC 27705-1505
(910) 827-3992
Mailing address
63 PRIDGEN RD, LUMBERTON, NC 28358-9726

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1174775969
BCBS
NC
05
1174775969
NC
Enumeration date
05/14/2020
Last updated
05/14/2020
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