Provider Demographics
NPI:1609981356
Name:PT BY THE SEA, INC
Entity Type:Organization
Organization Name:PT BY THE SEA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:HALLEMEYER
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:910-470-1121
Mailing Address - Street 1:2002 EASTWOOD RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7203
Mailing Address - Country:US
Mailing Address - Phone:910-256-4442
Mailing Address - Fax:910-256-4443
Practice Address - Street 1:2002 EASTWOOD RD STE 301
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7203
Practice Address - Country:US
Practice Address - Phone:910-256-4442
Practice Address - Fax:910-256-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001349283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2334246Medicare ID - Type UnspecifiedPHYSICAL THERAPY