| NPI | 1649568676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN KUCKO Director 704-360-2595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: NC NC-6830) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2021-04-07 |