Provider Demographics
NPI:1417353913
Name:ATLANTIC COAST PHYSICAL THERAPY & WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:ATLANTIC COAST PHYSICAL THERAPY & WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-729-9651
Mailing Address - Street 1:705 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-2327
Mailing Address - Country:US
Mailing Address - Phone:910-729-9651
Mailing Address - Fax:
Practice Address - Street 1:108 E H ST
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-2144
Practice Address - Country:US
Practice Address - Phone:910-729-9651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP6794261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy