Basic Information
| Provider Information | |||||||||
| NPI: | 1033123302 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE PHYSICAL THERAPY CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1526 E FRANKLIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199675959 | ||||||||
| FaxNumber: | 9199681478 | ||||||||
| Practice Location | |||||||||
| Address1: | 1526 E FRANKLIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199675959 | ||||||||
| FaxNumber: | 9199681478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | WATSON | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3365820244 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7200046 | 05 | NC | MEDICAID |