MEDICARE: CHARLOTTE ONE ON ONE PHYSICAL THERAPY

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	261QP2000X	Physical Therapy Clinic/Center	P11631	NC

General Provider Information

NPI Number	:	1932611324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLOTTE ONE ON ONE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	4310 PARK RD APT 103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-0006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 PARK RD APT 103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-0006
Country	:	US
Telephone Number	:	860-490-3072
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHLEEN WHITE
Credential	:	PT
Telephone Number	:	860-490-3072

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	10/25/2017

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Directions to “CHARLOTTE ONE ON ONE PHYSICAL THERAPY ” Practice Location

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