Provider Demographics
NPI:1740213321
Name:GOLDSBORO PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:GOLDSBORO PHYSICAL THERAPY & WELLNESS
Other - Org Name:GOLDSBORO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:919-734-1311
Mailing Address - Street 1:2503 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9401
Mailing Address - Country:US
Mailing Address - Phone:919-734-1311
Mailing Address - Fax:919-734-8816
Practice Address - Street 1:2503 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9401
Practice Address - Country:US
Practice Address - Phone:919-734-1311
Practice Address - Fax:919-734-8816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2023-02-20
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
NC7212029Medicaid
NC07885OtherBCBS OF NC
NC07885OtherBCBS OF NC
NC0356070001Medicare NSC