MEDICARE: PROACTIVE THERAPY OF NORTH CAROLINA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center		NC

General Provider Information

NPI Number	:	1568468502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROACTIVE THERAPY OF NORTH CAROLINA INC

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:	LEGAL DEPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	201 MCCULLOUGH DR STE 310
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-3577
Country	:	US
Telephone Number	:	704-547-1129
Fax Number	:	704-547-9056

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JOHN F DUGGAN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	10/21/2025

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