Provider Demographics
NPI:1164401568
Name:PHYSICAL THERAPY FOR THE CAROLINAS
Entity Type:Organization
Organization Name:PHYSICAL THERAPY FOR THE CAROLINAS
Other - Org Name:PT FOR THE CAROLINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:704-541-3378
Mailing Address - Street 1:3315 SPRINGBANK LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3197
Mailing Address - Country:US
Mailing Address - Phone:704-541-3378
Mailing Address - Fax:
Practice Address - Street 1:3315 SPRINGBANK LN
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3197
Practice Address - Country:US
Practice Address - Phone:704-541-3378
Practice Address - Fax:704-542-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016MNOtherBCBS GROUP
NC7211690Medicaid
NC2500630Medicare ID - Type Unspecified