Healthcare Provider Details

I. General information

NPI: 1063665263
Provider Name (Legal Business Name): ORTHOCAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 JOHN J DELANEY DR SUITE 140
CHARLOTTE NC
28277-3146
US

IV. Provider business mailing address

4601 PARK RD SUITE 300
CHARLOTTE NC
28209-3239
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-3278
  • Fax: 704-341-5269
Mailing address:
  • Phone: 704-323-2256
  • Fax: 704-323-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38865
License Number StateNC

VIII. Authorized Official

Name: DANNIEL B MURREY
Title or Position: CEO
Credential: M.D.
Phone: 704-323-2010