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General NPI Number Information
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NPI Number | 1588570055
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Entity Type | Organization
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Legal Business Name | ATHLETE STATE PHYSICAL THERAPY AND PERFORMANCE LLC
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 3833 CROSSBANE ST
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City | KANNAPOLIS
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State | NC
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Zip | 28081-7535
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Country | US
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Telephone | 434-841-1731
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Fax |
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Provider Business Mailing Address
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Address Line | 3833 CROSSBANE ST
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City | KANNAPOLIS
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State | NC
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Zip | 28081-7535
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Country | US
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Telephone | 434-841-1731
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. KENNETH RAY ALLISON III
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Credential | DPT
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Telephone | 434-841-1731
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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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