Healthcare Provider Details

I. General information

NPI: 1871503318
Provider Name (Legal Business Name): CHRISOPHER M KENT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 RANDOLPH RD FL 1
CHARLOTTE NC
28207-1101
US

IV. Provider business mailing address

PO BOX 601791
CHARLOTTE NC
28260-1791
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-3009
  • Fax: 704-323-3975
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT011406
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP10616
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: