Healthcare Provider Details

I. General information

NPI: 1588570055
Provider Name (Legal Business Name): ATHLETE STATE PHYSICAL THERAPY AND PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 CROSSBANE ST
KANNAPOLIS NC
28081-7535
US

IV. Provider business mailing address

3833 CROSSBANE ST
KANNAPOLIS NC
28081-7535
US

V. Phone/Fax

Practice location:
  • Phone: 434-841-1731
  • Fax:
Mailing address:
  • Phone: 434-841-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH RAY ALLISON III
Title or Position: CO-OWNER
Credential: DPT
Phone: 434-841-1731