Provider Demographics
NPI:1932396066
Name:CAROLINA ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:CAROLINA ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:SHANELL
Authorized Official - Last Name:BRIDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-367-1153
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-0054
Mailing Address - Country:US
Mailing Address - Phone:919-404-1448
Mailing Address - Fax:919-404-1613
Practice Address - Street 1:3108 GINGER LAKE CT
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-5737
Practice Address - Country:US
Practice Address - Phone:919-404-1448
Practice Address - Fax:919-404-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212306Medicaid