Healthcare Provider Details

I. General information

NPI: 1326705450
Provider Name (Legal Business Name): CAROLINA DECOMPRESSION AND PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11618 US HWY 70 W STE 106
CLAYTON NC
27520-2276
US

IV. Provider business mailing address

11618 US HWY 70 W STE 106
CLAYTON NC
27520-2276
US

V. Phone/Fax

Practice location:
  • Phone: 919-373-2000
  • Fax: 919-373-2200
Mailing address:
  • Phone: 919-373-2000
  • Fax: 919-373-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TYLER C SMITH
Title or Position: OWNER
Credential: PT
Phone: 919-373-2000