Provider Demographics
NPI:1669908505
Name:MY PT LLC
Entity type:Organization
Organization Name:MY PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGININA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:919-260-6912
Mailing Address - Street 1:112 QUAILVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-9337
Mailing Address - Country:US
Mailing Address - Phone:919-260-6912
Mailing Address - Fax:
Practice Address - Street 1:112 QUAILVIEW DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-9337
Practice Address - Country:US
Practice Address - Phone:919-260-6912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841595881OtherNPI
NCP14170OtherPT LICENSE
NCP14170OtherPT LICENSE