| NPI | 1538805981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHALA DAVIS Managed Care Assistant Director 704-303-7517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2022-05-09 |