Provider Demographics
NPI:1972633956
Name:CAROLINA REHAB INCORPORATION
Entity Type:Organization
Organization Name:CAROLINA REHAB INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FAULK,JR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CHT
Authorized Official - Phone:704-881-0088
Mailing Address - Street 1:889 SHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-4183
Mailing Address - Country:US
Mailing Address - Phone:704-881-0088
Mailing Address - Fax:704-881-0087
Practice Address - Street 1:889 SHERWOOD LANE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3414
Practice Address - Country:US
Practice Address - Phone:704-881-0088
Practice Address - Fax:704-881-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-04-07
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
NC250123BMedicare PIN