Healthcare Provider Details

I. General information

NPI: 1558100891
Provider Name (Legal Business Name): LIMITLESS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10761 PARK RD STE B
CHARLOTTE NC
28210-8535
US

IV. Provider business mailing address

2528 EMERALD BRANCH DR
HYATTSVILLE MD
20782-2605
US

V. Phone/Fax

Practice location:
  • Phone: 704-576-3218
  • Fax:
Mailing address:
  • Phone: 704-576-3218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN T HUBBARD
Title or Position: MD/OWNER
Credential: MD
Phone: 704-576-3218