Healthcare Provider Details

I. General information

NPI: 1114082922
Provider Name (Legal Business Name): ABC PEDIATRIC REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10620 STONE BUNKER DRIVE
MINT HILL NC
28227
US

IV. Provider business mailing address

PO BOX 691775
MINT HILL NC
28227-7030
US

V. Phone/Fax

Practice location:
  • Phone: 704-771-0051
  • Fax: 800-806-9071
Mailing address:
  • Phone: 704-771-0051
  • Fax: 800-806-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10550
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5989
License Number StateNC

VIII. Authorized Official

Name: MR. ALAN EDGAR WOLFE JR.
Title or Position: DIRECTOR OF OCCUPATIONAL THERAPY
Credential: MS OTR L
Phone: 704-771-0051