Provider Demographics
NPI:1740552090
Name:KINSTON PHYSICAL THERAPY & SPINE, LLC
Entity type:Organization
Organization Name:KINSTON PHYSICAL THERAPY & SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE/OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:252-208-0989
Mailing Address - Street 1:704 PLAZA BLVD
Mailing Address - Street 2:STE. C103
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1557
Mailing Address - Country:US
Mailing Address - Phone:252-208-0989
Mailing Address - Fax:252-208-0905
Practice Address - Street 1:704 PLAZA BLVD
Practice Address - Street 2:STE. C103
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1557
Practice Address - Country:US
Practice Address - Phone:252-208-0989
Practice Address - Fax:252-208-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200427Medicaid
NCB165Medicare PIN