Organization
CUSTOM REHABILITATION SPECIALITES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL SIDNEY THOMPSON (VICE PRESIDENT)
(910) 471-2962
Entity
Organization
Contact information
Practice address
4308 MAIDSTONE DR, WILMINGTON, NC 28405-7455
(910) 228-9808
(910) 791-7304
Mailing address
7225 ANACA POINT RD, WILMINGTON, NC 28411-9501
(910) 471-2962
(910) 791-7304
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
2055
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045NX
BCBS OF NC
NC
05
—
7701331
—
NC
Enumeration date
09/14/2006
Last updated
12/06/2011
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