Provider Demographics
NPI:1760453989
Name:PHYSICAL THERAPY OF NORTH CAROLINA, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF NORTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:ROEBER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:919-479-9001
Mailing Address - Street 1:4214 N. ROXBORO STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2122
Mailing Address - Country:US
Mailing Address - Phone:919-479-9001
Mailing Address - Fax:919-479-9003
Practice Address - Street 1:4214 N. ROXBORO STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2122
Practice Address - Country:US
Practice Address - Phone:919-479-9001
Practice Address - Fax:919-479-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2009-01-28
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
NC014A7OtherBCBS
NC014A7OtherBCBS