=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073137410
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORIGIN REHABILITATION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2020
-----------------------------------------------------
Last Update Date | 01/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7900 MATTHEWS MINT HILL RD STE 300
-----------------------------------------------------
City | MINT HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28227-6566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-905-1333
-----------------------------------------------------
Fax | 704-565-4285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7900 MATTHEWS MINT HILL RD STE 300
-----------------------------------------------------
City | MINT HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28227-6566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-905-1333
-----------------------------------------------------
Fax | 704-565-4285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER, PHYSICAL THERAPIST
-----------------------------------------------------
Name | MR. DAVID CHARLES REED III
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 704-905-1333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------