Provider Demographics
NPI:1912177395
Name:CAROLINA BALANCE AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:CAROLINA BALANCE AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:919-719-9839
Mailing Address - Street 1:3100 DURALEIGH RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8106
Mailing Address - Country:US
Mailing Address - Phone:919-719-9839
Mailing Address - Fax:919-719-9830
Practice Address - Street 1:3100 DURALEIGH RD
Practice Address - Street 2:SUITE 310
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8106
Practice Address - Country:US
Practice Address - Phone:919-719-9839
Practice Address - Fax:919-719-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDN4784OtherRAILROAD MEDICARE GROUP PTAN
NC020FEOtherBCBS
NCDN4784OtherRAILROAD MEDICARE GROUP PTAN