Provider Demographics
NPI:1689606840
Name:YOUR THERAPY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:YOUR THERAPY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:336-725-9787
Mailing Address - Street 1:5435 BELLE AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-9696
Mailing Address - Country:US
Mailing Address - Phone:336-725-9787
Mailing Address - Fax:336-725-9977
Practice Address - Street 1:775 W END BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2421
Practice Address - Country:US
Practice Address - Phone:336-725-9787
Practice Address - Fax:336-725-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079Y2OtherBCBS OF NC
NC2506955AMedicare PIN