MEDICARE: CHARLOTTE PHYSICAL THERAPY AND PERFORMANCE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1346908217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLOTTE PHYSICAL THERAPY AND PERFORMANCE, LLC

Provider Business Mailing Address
First Line	:	6809 HUNTFIELD DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-2822
Country	:	US
Telephone Number	:	910-322-4801
Fax Number	:

Provider Business Practice Location Address
First Line	:	6809 HUNTFIELD DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-2822
Country	:	US
Telephone Number	:	910-322-4801
Fax Number	:

Authorized Official
Title or Position	:	MANGER
Name	:	DR. PATRICK CASEY
Credential	:	PT, DPT
Telephone Number	:	910-322-4801

Provider Enumeration Date	:	12/07/2021
Last Update Date	:	12/07/2021

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