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General NPI Number Information
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NPI Number | 1275317562
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Entity Type | Organization
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Legal Business Name | CHARLOTTE MYOFUNCTIONAL THERAPY LLC
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 1308 THE PLZ APT F
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City | CHARLOTTE
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State | NC
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Zip | 28205-3679
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Country | US
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Telephone | 704-891-3262
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Fax |
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Provider Business Mailing Address
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Address Line | 309 MINDEN LN
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City | MATTHEWS
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State | NC
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Zip | 28105-9141
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Country | US
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Telephone | 607-738-6898
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Fax |
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Authorized Official
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Title or Position | MYOFUNCTIONAL THERAPIST
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Name | TRICIA BURT
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Credential |
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Telephone | 607-738-6898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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