Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 7727 | NC |
N | 2251S0007X | Physical Therapist - Sports | 7727 | NC |
N | 2251X0800X | Physical Therapist - Orthopedic | 7727 | NC |
NPI | 1477563062 |
---|---|
Provider Name | Jack Wayne Forehand |
First Address | Asheville, NC 28816-0518 |
Second Address | Asheville, NC 28806-8562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 07/02/2011 |