MEDICARE: INNER COASTAL PLAIN - PT, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QP2000X	Physical Therapy Clinic/Center
2	225100000X	Physical Therapist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1740069533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER COASTAL PLAIN - PT, LLC

Provider Business Mailing Address
First Line	:	150 FRANCAM DR STE 124
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-4500
Country	:	US
Telephone Number	:	910-229-3924
Fax Number	:	910-339-0537

Provider Business Practice Location Address
First Line	:	150 FRANCAM DR STE 124
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-4500
Country	:	US
Telephone Number	:	910-797-2148
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. GENNYTZA FURNE
Credential	:
Telephone Number	:	910-797-2148

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	01/21/2026

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