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General NPI Number Information
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NPI Number | 1316580574
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Entity Type | Organization
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Legal Business Name | SPECIALIZED PHYSICAL THERAPY OF THE CAROLINAS LLC
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Dates
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Enumeration Date | 10/21/2019
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 101 E ALLEN ST STE 103
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City | HENDERSONVILLE
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State | NC
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Zip | 28792-5091
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Country | US
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Telephone | 828-417-0160
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Fax | 828-417-3151
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Provider Business Mailing Address
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Address Line | 408 HIGUERA ST STE 200
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6135
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Country | US
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Telephone | 805-788-0805
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Fax | 805-788-0845
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELLY MARIE SANDERS
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Credential | PT, DPT
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Telephone | 805-788-0805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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