Provider Demographics
NPI:1861450884
Name:COMPREHENSIVE REHAB OF WILSON, INC.
Entity type:Organization
Organization Name:COMPREHENSIVE REHAB OF WILSON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:RODRI
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:I
Authorized Official - Credentials:PT,DPT,MBA
Authorized Official - Phone:252-243-7400
Mailing Address - Street 1:1811 FOREST HILLS RD W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3412
Mailing Address - Country:US
Mailing Address - Phone:252-243-7400
Mailing Address - Fax:252-243-3291
Practice Address - Street 1:1811 FOREST HILLS RD W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3412
Practice Address - Country:US
Practice Address - Phone:252-243-7400
Practice Address - Fax:252-243-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0777YOtherBCBS OF NC
NC720777YMedicaid
NC0777YOtherBCBS OF NC