Provider Demographics
NPI:1750342549
Name:RINALDO, ANTHONY C JR (PT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:RINALDO
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 LE PHILLIP CT NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1905
Mailing Address - Country:US
Mailing Address - Phone:704-707-4282
Mailing Address - Fax:
Practice Address - Street 1:236 LE PHILLIP CT NE
Practice Address - Street 2:SUITE A
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1905
Practice Address - Country:US
Practice Address - Phone:704-707-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001262Medicaid
WV4162091Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID