Provider Demographics
NPI:1184242554
Name:NEW CASTLE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:NEW CASTLE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:423-284-2399
Mailing Address - Street 1:501 FOREST LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2621
Mailing Address - Country:US
Mailing Address - Phone:864-722-0335
Mailing Address - Fax:
Practice Address - Street 1:6420 COUNTY ROAD 335 UNIT B
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:CO
Practice Address - Zip Code:81647-9691
Practice Address - Country:US
Practice Address - Phone:401-213-9842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-11
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619357696OtherINDIVIDUAL NPI NUMBER BEFORE I CREATED THIS BUSINESS