Provider Demographics
NPI:1891089249
Name:CAROLINA PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:CAROLINA PHYSICAL THERAPY, LLC
Other - Org Name:BODY MECHANIX REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYTHE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:940-230-5894
Mailing Address - Street 1:6101 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-6221
Mailing Address - Country:US
Mailing Address - Phone:940-230-5899
Mailing Address - Fax:
Practice Address - Street 1:16633 DALLAS PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6816
Practice Address - Country:US
Practice Address - Phone:972-380-0000
Practice Address - Fax:972-380-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1172932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty