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General NPI Number Information
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NPI Number | 1235502790
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Entity Type | Organization
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Legal Business Name | NOVANT MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 950 KIMBALL RD
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City | CHINA GROVE
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State | NC
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Zip | 28023-9594
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Country | US
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Telephone | 704-639-0055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone | 704-384-7840
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Fax | 704-384-7830
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | GEOFFREY K GARDNER
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Credential |
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Telephone | 704-639-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | NC
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Taxonomy #2
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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 | NC
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