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General NPI Number Information
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NPI Number | 1386037828
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Entity Type | Organization
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Legal Business Name | SELECT PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 301 W 10TH ST APT101
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City | CHARLOTTE
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State | NC
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Zip | 28202-1739
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Country | US
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Telephone | 614-361-7603
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Fax |
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Provider Business Mailing Address
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Address Line | 301 W 10TH ST APT101
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City | CHARLOTTE
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State | NC
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Zip | 28202-1739
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Country | US
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Telephone | 614-361-7603
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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 | MR. KYLE HILLARD
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Credential |
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Telephone | 614-361-7603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 15449
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License Number State | NC
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