Provider Demographics
NPI:1437464732
Name:CAROLINA THERAPY
Entity Type:Organization
Organization Name:CAROLINA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISHKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-542-4800
Mailing Address - Street 1:7108 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8187
Mailing Address - Country:US
Mailing Address - Phone:704-542-4800
Mailing Address - Fax:704-542-4808
Practice Address - Street 1:7108 PINEVILLE MATTHEWS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8187
Practice Address - Country:US
Practice Address - Phone:704-542-4800
Practice Address - Fax:704-542-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122951261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)