MEDICARE: CAROLINA PRIME PHYSICAL THERAPY

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	P10047	NC
2	261QR0400X	Rehabilitation Clinic/Center	8609	NC
3	261QR0400X	Rehabilitation Clinic/Center	P10047	NC
4	208100000X	Physical Medicine & Rehabilitation Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902392418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA PRIME PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	343 FOREST GLEN LN
Second Line	:
City	:	WILKESBORO
State	:	NC
Zip	:	28697-7000
Country	:	US
Telephone Number	:	336-990-1028
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W PARK CIR STE A
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3583
Country	:	US
Telephone Number	:	336-818-2700
Fax Number	:	336-450-1700

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SCOTT FORREST
Credential	:	PT COMT
Telephone Number	:	336-990-1028

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	08/20/2023

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Directions to “CAROLINA PRIME PHYSICAL THERAPY ” Practice Location

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