Healthcare Provider Details

I. General information

NPI: 1407085418
Provider Name (Legal Business Name): CORE THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2009
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 NEW POINTE BLVD SUITE B-6
LELAND NC
28451-4127
US

IV. Provider business mailing address

1107 NEW POINTE BLVD SUITE B-6
LELAND NC
28451-4127
US

V. Phone/Fax

Practice location:
  • Phone: 910-399-1922
  • Fax: 866-844-3505
Mailing address:
  • Phone: 910-399-1922
  • Fax: 866-844-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN C TANTILLA
Title or Position: PRESIDENT / CO-OWNER
Credential: PT
Phone: 910-399-1922