Provider Demographics
NPI:1720694482
Name:POWELL PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:POWELL PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JAY SCOTT
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:910-302-5200
Mailing Address - Street 1:416 ANTIOCH LAKES RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-1000
Mailing Address - Country:US
Mailing Address - Phone:910-551-0724
Mailing Address - Fax:
Practice Address - Street 1:2105 NC 410 HWY
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320-8053
Practice Address - Country:US
Practice Address - Phone:910-876-7424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy