Healthcare Provider Details

I. General information

NPI: 1629834502
Provider Name (Legal Business Name): MVMT TEMPLE REHAB & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 YORKFORD DR
CHARLOTTE NC
28269-8950
US

IV. Provider business mailing address

3907 YORKFORD DR
CHARLOTTE NC
28269-8950
US

V. Phone/Fax

Practice location:
  • Phone: 252-258-3719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GARRISON CHERRY
Title or Position: EMPLOYEE
Credential:
Phone: 252-258-3719