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General NPI Number Information
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NPI Number | 1083498067
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Entity Type | Organization
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Legal Business Name | ULTIMATE REHABILITATION AND WELLNESS LLC
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 123 E 27TH STREET UNIT 103
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City | CHARLOTTE
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State | NC
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Zip | 28206
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Country | US
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Telephone | 704-565-9513
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 HEATHERS MIST AVE
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City | CHARLOTTE
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State | NC
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Zip | 28213-5216
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | OLUEBUBE C NDUKA
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Credential | DPT
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Telephone | 862-237-2457
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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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