Provider Demographics
NPI:1609407568
Name:LAUREL RIDGE PHYSICAL THERAPY & ASSOCIATES
Entity Type:Organization
Organization Name:LAUREL RIDGE PHYSICAL THERAPY & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:919-444-7151
Mailing Address - Street 1:3188 SILER CTY SNOW CP RD
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-7232
Mailing Address - Country:US
Mailing Address - Phone:919-444-7151
Mailing Address - Fax:888-220-3443
Practice Address - Street 1:3188 SILER CTY SNOW CP RD
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-7232
Practice Address - Country:US
Practice Address - Phone:919-444-7151
Practice Address - Fax:888-220-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty