MEDICARE: ALLISON J FENDER PT

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	6960	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3734647	OTHER	TN	GROUP PRICING NUMBER

General Provider Information

NPI Number	:	1770590051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON J FENDER PT

Provider Business Mailing Address
First Line	:	2725 WATER RIDGE PKWY
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-4580
Country	:	US
Telephone Number	:	704-831-5065
Fax Number	:	704-831-5066

Provider Business Practice Location Address
First Line	:	2725 WATER RIDGE PKWY
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-4580
Country	:	US
Telephone Number	:	704-831-5065
Fax Number	:	704-831-5066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/20/2007

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Directions to “ ALLISON J FENDER PT” Practice Location

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