MEDICARE: CAROLINA MOBILE PHYSICAL THERAPY, LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1720769649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA MOBILE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	121 RIBBON WALK LN
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-4469
Country	:	US
Telephone Number	:	919-539-8075
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 RIBBON WALK LN
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-4469
Country	:	US
Telephone Number	:	919-539-8075
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SARA ELIZABETH ROBERTS
Credential	:	PT, DPT
Telephone Number	:	919-539-8075

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/25/2023

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