Provider Demographics
NPI:1700347994
Name:DOCTOR OF PHYSICAL THERAPY
Entity Type:Organization
Organization Name:DOCTOR OF PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEASIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:910-914-6161
Mailing Address - Street 1:2450 OTTO NANCE RD
Mailing Address - Street 2:
Mailing Address - City:CERRO GORDO
Mailing Address - State:NC
Mailing Address - Zip Code:28430-0242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 HILL PLZ
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4950
Practice Address - Country:US
Practice Address - Phone:910-914-6161
Practice Address - Fax:910-685-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty