Provider Demographics
NPI:1487198107
Name:PHYSICAL THERAPY AT GOLDSBORO SPINE CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AT GOLDSBORO SPINE CENTER, LLC
Other - Org Name:ALIEN GEAR REAL ESTATE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE JOY
Authorized Official - Middle Name:YUMUL
Authorized Official - Last Name:CO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-547-7790
Mailing Address - Street 1:605 N SPENCE AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534
Mailing Address - Country:US
Mailing Address - Phone:919-751-0555
Mailing Address - Fax:919-751-3001
Practice Address - Street 1:605 N SPENCE AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534
Practice Address - Country:US
Practice Address - Phone:919-751-0555
Practice Address - Fax:919-751-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16455225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty