Provider Demographics
NPI:1619155819
Name:EASTERN THERAPEUTIC SERVICES, INC.
Entity Type:Organization
Organization Name:EASTERN THERAPEUTIC SERVICES, INC.
Other - Org Name:ONSLOW REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:TOLSON
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:910-326-3066
Mailing Address - Street 1:146 STEWART POINT RD
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-3440
Mailing Address - Country:US
Mailing Address - Phone:910-326-3066
Mailing Address - Fax:910-326-3231
Practice Address - Street 1:146 STEWART POINT RD
Practice Address - Street 2:
Practice Address - City:HUBERT
Practice Address - State:NC
Practice Address - Zip Code:28539-3440
Practice Address - Country:US
Practice Address - Phone:910-326-3066
Practice Address - Fax:910-326-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC643261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1C2501419Medicare PIN