1710924105 NPI number — METRO PHYSICAL THERAPY ASSOCIATES

Table of content: (NPI 1710924105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710924105 NPI number — METRO PHYSICAL THERAPY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO PHYSICAL THERAPY ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710924105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9815 SAM FURR RD
Provider Second Line Business Mailing Address:
SUITE J #81
Provider Business Mailing Address City Name:
HUNTERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28078-4901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-701-4976
Provider Business Mailing Address Fax Number:
704-895-9669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15431 CROSSING GATE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORNELIUS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28031-8130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-701-4976
Provider Business Practice Location Address Fax Number:
704-895-9669
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WINTZ
Authorized Official First Name:
DWAINE
Authorized Official Middle Name:
HYMAN
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
701-704-4976

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  9846 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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