Provider Demographics
NPI:1598802415
Name:PHYSICAL RECOVERY, LLC
Entity Type:Organization
Organization Name:PHYSICAL RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-382-0150
Mailing Address - Street 1:3400 CROASDAILE DR
Mailing Address - Street 2:STE. 201
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6815
Mailing Address - Country:US
Mailing Address - Phone:919-382-0150
Mailing Address - Fax:919-382-3390
Practice Address - Street 1:3400 CROASDAILE DR
Practice Address - Street 2:STE. 201
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6815
Practice Address - Country:US
Practice Address - Phone:919-382-0150
Practice Address - Fax:919-382-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211223Medicaid
NC0786EOtherGROUP BCBS
NC2500850Medicare ID - Type UnspecifiedGROUP MEDICARE