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General NPI Number Information
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NPI Number | 1487451969
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Entity Type | Organization
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Legal Business Name | R3PT AND WELLNESS LLC
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 6203 CLEBURNE CT
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City | CHARLOTTE
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State | NC
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Zip | 28217-0432
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Country | US
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Telephone | 919-923-0758
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Fax |
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Provider Business Mailing Address
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Address Line | 6203 CLEBURNE CT
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City | CHARLOTTE
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State | NC
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Zip | 28217-0432
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Country | US
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Telephone | 919-923-0758
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. OLIVER CANAHUATE
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Credential |
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Telephone | 919-923-0758
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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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