Provider Demographics
NPI:1245585371
Name:CAROLINA WOUND CARE AND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CAROLINA WOUND CARE AND PHYSICAL THERAPY
Other - Org Name:CAROLINA WOUND THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INDIA
Authorized Official - Middle Name:REID
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CWS, CPC
Authorized Official - Phone:336-788-1119
Mailing Address - Street 1:425 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-5035
Mailing Address - Country:US
Mailing Address - Phone:336-707-7257
Mailing Address - Fax:336-788-1145
Practice Address - Street 1:425 W 24TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-5035
Practice Address - Country:US
Practice Address - Phone:336-707-7257
Practice Address - Fax:336-788-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-15
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP8176261QH0100X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB555Medicare PIN
NC6730090001Medicare NSC
NC7213053Medicaid