Provider Demographics
NPI:1417900382
Name:CAROLINA KIDS THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:CAROLINA KIDS THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARY-COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:704-293-1856
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-0628
Mailing Address - Country:US
Mailing Address - Phone:704-293-1856
Mailing Address - Fax:704-987-3704
Practice Address - Street 1:16818 BRIDGETON LN
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4837
Practice Address - Country:US
Practice Address - Phone:704-293-1856
Practice Address - Fax:704-987-3704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079N6OtherBCBS
NC7212035Medicaid