Eden Sports, Inc.

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

EDEN SPORTS, INC.

Practice address

110 S Park Ter
Eden, NC 27288-5351

Phone

(800) 364-0690

Fax

(336) 623-1919

NPI assigned

Jul 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jayne Fleck Pool

Title

Chief Compliance Officer

Phone

(469) 467-8705

Specialties & licenses 1

Addresses

Other names 1

• Therasport Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245024000000",
    "number": "1467486308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 PHILADELPHIA ST",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013941",
            "telephone_number": "724-465-3496",
            "fax_number": "724-465-3726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S PARK TER",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272885351",
            "telephone_number": "800-364-0690",
            "fax_number": "336-623-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN SPORTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2009-06-15",
        "status": "A",
        "authorized_official_last_name": "POOL",
        "authorized_official_first_name": "JAYNE",
        "authorized_official_middle_name": "FLECK",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "469-467-8705",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Therasport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eden Drug, Inc.
• Eden Health & Wellness Center
• Eden Internal Medicine PLLC
• Eden Internal Medicine PLLC
• Eden Opco LLC
• John R Edwards, MD
• James Harrison Eggleston, DDS PA
• Cheryl Denise Ellixson, LCMHC
• Emergeortho PA
• Ricky L Emerson

• All providers in Eden, NC
• Physical Therapy Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.