Organization
LEGACY HEALTHCARE SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM G WILSON JR. (CFO)
(919) 424-5080
Entity
Organization
Contact information
Practice address
2770 S ADAMS ST, BLOOMINGTON, IN 47403-3242
(812) 323-4661
(812) 323-4665
Mailing address
110 HORIZON DR STE 310, RALEIGH, NC 27615-4926
(910) 724-7770
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
08/28/2014
Last updated
06/10/2022
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