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General NPI Number Information
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NPI Number | 1316501646
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Entity Type | Organization
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Legal Business Name | ONWARD CHARLOTTE LLC
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 12/21/2020
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Provider Practice Location Address
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Address Line | 529 W SUMMIT AVE STE 1D
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City | CHARLOTTE
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State | NC
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Zip | 28203-4350
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Country | US
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Telephone | 336-467-1453
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Fax |
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Provider Business Mailing Address
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Address Line | 529 W SUMMIT AVE STE 1D
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City | CHARLOTTE
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State | NC
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Zip | 28203-4400
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Country | US
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Telephone | 704-228-3825
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JORDAN BERRY
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Credential | DPT
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Telephone | 336-467-1453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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