Healthcare Provider Details

I. General information

NPI: 1427668227
Provider Name (Legal Business Name): PRO REHAB NOW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 09/24/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9716 REA RD STE B PBM 1025
MINT HILL NC
28277-9305
US

IV. Provider business mailing address

9716 REA RD STE B PBM 1025
MINT HILL NC
28277-9305
US

V. Phone/Fax

Practice location:
  • Phone: 980-288-6225
  • Fax: 704-285-2311
Mailing address:
  • Phone: 980-288-6225
  • Fax: 704-285-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. VONDA CRISWELL
Title or Position: SPEECH-LANGUAGE PATHOLOGIST/OWNER
Credential: MA,CCC-SLP
Phone: 980-288-6225