Healthcare Provider Details

I. General information

NPI: 1972533883
Provider Name (Legal Business Name): TEAM THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19215 PENINSULA SHORES DR
CORNELIUS NC
28031-7579
US

IV. Provider business mailing address

19215 PENINSULA SHORES DR
CORNELIUS NC
28031-7579
US

V. Phone/Fax

Practice location:
  • Phone: 704-895-7343
  • Fax:
Mailing address:
  • Phone: 704-895-7343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP5385
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberP5385
License Number StateNC

VIII. Authorized Official

Name: MRS. MICHELLE ROBERTSON
Title or Position: PHYSICAL THERAPIST / OWNER
Credential: P.T.
Phone: 704-895-7343