Healthcare Provider Details

I. General information

NPI: 1184242554
Provider Name (Legal Business Name): NEW CASTLE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 COUNTY ROAD 335 UNIT B
NEW CASTLE CO
81647-9691
US

IV. Provider business mailing address

501 FOREST LN SUITE A
CLEMSON SC
29631-2621
US

V. Phone/Fax

Practice location:
  • Phone: 401-213-9842
  • Fax:
Mailing address:
  • Phone: 864-722-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS PETERSON
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: PT, DPT
Phone: 423-284-2399