Provider Demographics
NPI:1891216362
Name:CAROLINA BEACH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CAROLINA BEACH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:910-309-8141
Mailing Address - Street 1:1300 BRIDGE BARRIER RD
Mailing Address - Street 2:BLDG 3
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-4808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 BRIDGE BARRIER RD STE 3
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-3939
Practice Address - Country:US
Practice Address - Phone:910-309-8141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy