Provider Demographics
NPI:1508094657
Name:NESTLERODE ORTHOPEDIC REHABILITATION, LLC
Entity Type:Organization
Organization Name:NESTLERODE ORTHOPEDIC REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:NESTLERODE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:704-692-0317
Mailing Address - Street 1:405 E MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4427
Mailing Address - Country:US
Mailing Address - Phone:252-966-0077
Mailing Address - Fax:877-566-1181
Practice Address - Street 1:405 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4866
Practice Address - Country:US
Practice Address - Phone:252-966-0077
Practice Address - Fax:877-566-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-28
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty