Healthcare Provider Details

I. General information

NPI: 1053545988
Provider Name (Legal Business Name): PHYSICAL THERAPY CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 DICKERSON BLVD STE D
MONROE NC
28110-2884
US

IV. Provider business mailing address

1730 DICKERSON BLVD STE D
MONROE NC
28110-2884
US

V. Phone/Fax

Practice location:
  • Phone: 704-283-6700
  • Fax: 704-283-6700
Mailing address:
  • Phone: 704-283-6700
  • Fax: 704-283-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9417
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD DOUGLAS KOOS
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 704-502-9205