MEDICARE: CAROLINA PHYSICAL THERAPY ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011E0	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1629022199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA PHYSICAL THERAPY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 150
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45802-0150
Country	:	US
Telephone Number	:	419-221-6717
Fax Number	:	419-222-0507

Provider Business Practice Location Address
First Line	:	627 E WASHINGTON ST
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-1737
Country	:	US
Telephone Number	:	252-459-5565
Fax Number	:	252-459-5568

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	STEPHEN KRZYMINSKI
Credential	:
Telephone Number	:	419-221-6717

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	09/06/2023

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