Provider Demographics
NPI:1316256928
Name:PHYSICAL THERAPY OF SOUTHERN PINES, LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY OF SOUTHERN PINES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:GOLDENBERG
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:910-723-0802
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28388-0536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 N BENNETT ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4833
Practice Address - Country:US
Practice Address - Phone:910-723-0802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty