Healthcare Provider Details

I. General information

NPI: 1225691488
Provider Name (Legal Business Name): JACOB SCHUR PHYSICAL THERAPY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 BALLANTYNE MEDICAL PL
CHARLOTTE NC
28277-4652
US

IV. Provider business mailing address

4601 PARK RD STE 300
CHARLOTTE NC
28209-2290
US

V. Phone/Fax

Practice location:
  • Phone: 43-233-4097
  • Fax: 704-323-3982
Mailing address:
  • Phone: 704-323-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0004185
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21179
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: