1124719778 NPI number — NC PHYSICAL THERAPY AND BALANCE LLC

Table of content: (NPI 1124719778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124719778 NPI number — NC PHYSICAL THERAPY AND BALANCE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NC PHYSICAL THERAPY AND BALANCE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124719778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 SARAHCREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607-4866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-498-7048
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3010 ANDERSON DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-7720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
199-244-2225
Provider Business Practice Location Address Fax Number:
919-446-3959
Provider Enumeration Date:
05/16/2023

Additional Information

Authorized Official

Authorized Official Last Name:
FREATHY
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
ALLAN
Authorized Official Title or Position:
OWNER MANAGER
Authorized Official Telephone Number:
813-498-7048

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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