Provider Demographics
NPI:1376559047
Name:PRYBYLO ESS PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PRYBYLO ESS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESS
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:336-765-4542
Mailing Address - Street 1:1541 WESTBROOK PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-765-4542
Mailing Address - Fax:336-765-0231
Practice Address - Street 1:1541 WESTBROOK PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-765-4542
Practice Address - Fax:336-765-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC346596OtherMEDICARE A
NC232050OtherMEDICARE B
NC1710063151OtherNPI / ROBERT J ESS
NC07798OtherBCBS
NC250012BOtherMEDICARE B/ ROBERT J ESS
NC250013BOtherMCR/B SHARON A PRYBYLO
NC346596OtherMEDICARE A