Provider Demographics
NPI:1285615542
Name:NORTHEASTERN CAROLINA PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:NORTHEASTERN CAROLINA PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:252-535-4809
Mailing Address - Street 1:114 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3221
Mailing Address - Country:US
Mailing Address - Phone:252-535-4809
Mailing Address - Fax:252-535-1040
Practice Address - Street 1:114 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3221
Practice Address - Country:US
Practice Address - Phone:252-535-4809
Practice Address - Fax:252-535-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-13
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7201037Medicaid
NC346588Medicare ID - Type Unspecified