Provider Demographics
NPI:1730284720
Name:PHYSICAL THERAPY COACH, INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY COACH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:919-303-2217
Mailing Address - Street 1:1051 PEMBERTON HILL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4267
Mailing Address - Country:US
Mailing Address - Phone:919-303-2217
Mailing Address - Fax:919-303-6124
Practice Address - Street 1:1051 PEMBERTON HILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4267
Practice Address - Country:US
Practice Address - Phone:919-303-2217
Practice Address - Fax:919-303-6124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212001Medicaid
NC2340159Medicare ID - Type UnspecifiedMEDICARE ID NUMBER