Organization
HAVELOCK PEAK PERFORMANCE SPORTS & PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH LAURENT (AUTHORIZED OFFICIAL)
(616) 356-5011
Entity
Organization
Contact information
Practice address
1202 E MAIN ST, HAVELOCK, NC 28532-2405
(252) 447-4005
(252) 447-4001
Mailing address
PO BOX 13609, NEW BERN, NC 28561-3609
(252) 636-9800
(252) 636-1945
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
N/A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017XX
BCBSNC
NC
05
—
7212000
—
NC
Enumeration date
03/23/2006
Last updated
04/30/2018
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