Provider Demographics
NPI:1326705450
Name:CAROLINA DECOMPRESSION AND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CAROLINA DECOMPRESSION AND PHYSICAL THERAPY LLC
Other - Org Name:CAROLINA SPINE AND DISC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:919-373-2000
Mailing Address - Street 1:11618 US HWY 70 W STE 106
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2276
Mailing Address - Country:US
Mailing Address - Phone:919-373-2000
Mailing Address - Fax:919-373-2200
Practice Address - Street 1:11618 US HWY 70 W STE 106
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2276
Practice Address - Country:US
Practice Address - Phone:919-373-2000
Practice Address - Fax:919-373-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty