Healthcare Provider Details

I. General information

NPI: 1487127262
Provider Name (Legal Business Name): B.WELL PHYSIO AND WELLNESS CONTINUUM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8208 MCCARRON WAY
CHARLOTTE NC
28215-8716
US

IV. Provider business mailing address

8208 MCCARRON WAY
CHARLOTTE NC
28215-8716
US

V. Phone/Fax

Practice location:
  • Phone: 704-565-9192
  • Fax: 844-230-6504
Mailing address:
  • Phone: 704-565-9192
  • Fax: 844-230-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIAN JODI DAVIS
Title or Position: OWNER
Credential: DPT
Phone: 704-565-9192