Provider Demographics
NPI:1881647006
Name:COMPREHENSIVE REHABILITATION OF THE CAROLINAS, PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE REHABILITATION OF THE CAROLINAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:OMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-942-5872
Mailing Address - Street 1:PO BOX 38176
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-1002
Mailing Address - Country:US
Mailing Address - Phone:704-942-5872
Mailing Address - Fax:866-227-0449
Practice Address - Street 1:600 FULLWOOD RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2659
Practice Address - Country:US
Practice Address - Phone:704-942-5872
Practice Address - Fax:866-227-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicare ID - Type UnspecifiedGROUP