Individual
MR. JOHN RAYMOND MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1720 W US HIGHWAY 19E, BURNSVILLE, NC 28714-8602
(828) 682-1500
(828) 682-1505
Mailing address
PO BOX 1358, BURNSVILLE, NC 28714-1358
(828) 682-1500
(828) 682-1505
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4787
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350866700
US DEPT OF LABOR
NC
01
—
58457
BLUE CROSS BLUE SHIELD
NC
01
—
64-0006
UNITED HEALTHCARE
NC
01
—
65002114
MEDICARE RAILROAD
NC
05
—
7210872
—
NC
01
—
MEDCOST
MEDCOST
NC
Enumeration date
09/09/2005
Last updated
04/05/2011
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