Provider Demographics
NPI:1740600188
Name:CARRBORO PEDIATRIC PHYSICAL THERAPY,LLC
Entity type:Organization
Organization Name:CARRBORO PEDIATRIC PHYSICAL THERAPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:415-317-7049
Mailing Address - Street 1:101 THOMAS LN APT C2
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1362
Mailing Address - Country:US
Mailing Address - Phone:415-317-7049
Mailing Address - Fax:919-883-5471
Practice Address - Street 1:101 THOMAS LN APT C2
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1362
Practice Address - Country:US
Practice Address - Phone:415-317-7049
Practice Address - Fax:919-883-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty