MEDICARE: SAM MCKELVEY 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	5709	SC
2	225100000X	Physical Therapist	9151	NC

General Provider Information

NPI Number	:	1902861313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM MCKELVEY PT

Provider Business Mailing Address
First Line	:	311 PORT ROYAL DR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-1573
Country	:	US
Telephone Number	:	704-654-9838
Fax Number	:

Provider Business Practice Location Address
First Line	:	5960 FAIRVIEW RD
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3102
Country	:	US
Telephone Number	:	704-654-9838
Fax Number	:

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	05/30/2008

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Directions to “ SAM MCKELVEY PT” Practice Location

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