Healthcare Provider Details

I. General information

NPI: 1700642469
Provider Name (Legal Business Name): USPC SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9319 ROBERT D. SNYDER RD SUITE 418
CHARLOTTE NC
28223
US

IV. Provider business mailing address

9319 ROBERT D. SNYDER RD SUITE 416
CHARLOTTE NC
28223
US

V. Phone/Fax

Practice location:
  • Phone: 980-395-9091
  • Fax:
Mailing address:
  • Phone: 980-395-9091
  • 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: IRWIN BELK
Title or Position: MANAGER
Credential:
Phone: 980-257-0771