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General NPI Number Information
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NPI Number | 1023723798
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/17/2023
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 1531 CINEMA DR STE C
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City | STATESVILLE
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State | NC
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Zip | 28625-5403
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Country | US
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Telephone | 980-443-6070
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Fax | 980-443-6070
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Provider Business Mailing Address
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Address Line | 133 RIDING TRL
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City | MOORESVILLE
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State | NC
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Zip | 28117-9165
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Country | US
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Telephone | 704-578-1374
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Fax | 980-443-6070
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD STEWART
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Credential | PT, DPT, OCS, DN
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Telephone | 704-746-0022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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