Provider Demographics
NPI:1497724660
Name:KJC CORP
Entity Type:Organization
Organization Name:KJC CORP
Other - Org Name:ADVANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-932-7266
Mailing Address - Street 1:77 S ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5827
Mailing Address - Country:US
Mailing Address - Phone:919-932-7266
Mailing Address - Fax:919-932-7250
Practice Address - Street 1:77 S ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5827
Practice Address - Country:US
Practice Address - Phone:919-932-7266
Practice Address - Fax:919-932-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2024-01-17
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
DU4453OtherRAILROAD MEDICARE
NC013CAOtherBLUE CROSS OF NC
NC013CAOtherBLUE CROSS OF NC
NC=========OtherTRICARE