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Organization

CAROLINA MANUAL THERAPY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CAROLINA ANN CANDELARIA MSPT (MANAGING MEMBER)
(910) 278-6794
Entity
Organization

Contact information

Practice address
618 N HOWE ST, SOUTHPORT, NC 28461-3426
(910) 278-6794
(910) 278-7694
Mailing address
301 NE 42ND ST, OAK ISLAND, NC 28465-5450
(910) 278-6794
(910) 278-6794

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2675
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
079CK
BLUE CROSS BLUE SHIELD
NC
Enumeration date
05/16/2006
Last updated
08/22/2020
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