=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063928364
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOVEMENT SOLUTIONS PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2017
-----------------------------------------------------
Last Update Date | 12/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10345 NATIONS FORD RD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28273-5822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-604-0568
-----------------------------------------------------
Fax | 704-394-9587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10030 CALLABRIDGE CT
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28216-2421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-604-0568
-----------------------------------------------------
Fax | 704-394-9587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LEON KNIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-604-0568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | P15816
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------