Eden Sports, Inc.

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

EDEN SPORTS, INC.

Doing business as

Therasport

Practice address

4446 US Highway 220 N Ste a
Summerfield Village
Summerfield, NC 27358-9415

Phone

(336) 643-7335

Fax

(336) 643-7365

NPI assigned

Jul 10, 2006

Last updated

Jun 15, 2009By the provider in NPPES

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": "1902830284",
    "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": "4446 US HIGHWAY 220 N STE A",
            "address_2": "SUMMERFIELD VILLAGE",
            "city": "SUMMERFIELD",
            "state": "NC",
            "postal_code": "273589415",
            "telephone_number": "336-643-7335",
            "fax_number": "336-643-7365"
        }
    ],
    "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Therasport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapy Clinic/Center in Summerfield, NC
• Providers in Summerfield, NC by specialty
• 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.