Healthcare Provider Details

I. General information

NPI: 1124609409
Provider Name (Legal Business Name): PTFORHER PELVIC HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2021
Last Update Date: 04/18/2021
Certification Date: 04/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 LAMAR AVE STE 214
CHARLOTTE NC
28204-2436
US

IV. Provider business mailing address

322 LAMAR AVE STE 214
CHARLOTTE NC
28204-2436
US

V. Phone/Fax

Practice location:
  • Phone: 803-526-7876
  • Fax:
Mailing address:
  • Phone: 803-526-7876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. QUANA TRIBBLE
Title or Position: OWNER
Credential: DPT
Phone: 803-526-7876