Provider Demographics
NPI:1932683299
Name:CAROLINA DANCER WELLNESS
Entity Type:Organization
Organization Name:CAROLINA DANCER WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KESKITALO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:919-415-1318
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-0329
Mailing Address - Country:US
Mailing Address - Phone:919-251-5775
Mailing Address - Fax:
Practice Address - Street 1:216 E CHATHAM ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3499
Practice Address - Country:US
Practice Address - Phone:919-415-1318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty