Healthcare Provider Details

I. General information

NPI: 1538613302
Provider Name (Legal Business Name): BRAIN TRAINING CENTER OF CHARLOTTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10030 EDISON SQUARE DR NW
CONCORD NC
28027-8308
US

IV. Provider business mailing address

10030 EDISON SQUARE DR NW
CONCORD NC
28027-8308
US

V. Phone/Fax

Practice location:
  • Phone: 704-499-8888
  • Fax: 704-499-8888
Mailing address:
  • Phone: 704-499-8888
  • Fax: 704-499-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA CLARK HENDERSON
Title or Position: PARTNER AND OPERATIONS MANAGER
Credential:
Phone: 865-386-3470