Healthcare Provider Details

I. General information

NPI: 1699711507
Provider Name (Legal Business Name): CAROLINA PHYSICAL REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 JONES ST
MARSHVILLE NC
28103-1231
US

IV. Provider business mailing address

507 JONES ST PO BOX 237
MARSHVILLE NC
28103-1231
US

V. Phone/Fax

Practice location:
  • Phone: 704-624-0346
  • Fax: 704-624-0356
Mailing address:
  • Phone: 704-624-0346
  • Fax: 704-624-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number7131
License Number StateNC

VIII. Authorized Official

Name: MRS. SHADE F BADA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 704-624-0346