Healthcare Provider Details

I. General information

NPI: 1316124332
Provider Name (Legal Business Name): HEALTH AND REHABILITATION PSYCHOLOGISTS OF CHARLOTTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 E 7TH ST
CHARLOTTE NC
28204-4375
US

IV. Provider business mailing address

2610 E 7TH ST
CHARLOTTE NC
28204-4375
US

V. Phone/Fax

Practice location:
  • Phone: 704-375-8900
  • Fax: 704-335-7178
Mailing address:
  • Phone: 704-375-8900
  • Fax: 704-335-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number200001523745
License Number StateNC

VIII. Authorized Official

Name: DR. WALTER BRIAN O'MALLEY
Title or Position: OWNER/DIRECTOR
Credential: PH.D.
Phone: 704-375-8900