Organization
CAROLINA MANUAL THERAPY LLC
Active
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
Update your record
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