1861934010 NPI number — PHYSICAL THERAPY CENTER TWO, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861934010 NPI number — PHYSICAL THERAPY CENTER TWO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY CENTER TWO, LLC
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:
6
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:
1861934010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1730 DICKERSON BLVD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28110-2885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-283-6700
Provider Business Mailing Address Fax Number:
704-283-6713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 SOUTH BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-283-6700
Provider Business Practice Location Address Fax Number:
704-283-6713
Provider Enumeration Date:
11/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KOOS
Authorized Official First Name:
TODD
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-502-9205

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  P9417 , 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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