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General NPI Number Information
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NPI Number | 1669772802
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Entity Type | Organization
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Legal Business Name | ATHELITE PHYSICAL PERFORMANCE CENTER OF LAKE NORMAN, LLC
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 2809 AMITY HILL RD
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City | STATESVILLE
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State | NC
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Zip | 28677-9744
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Country | US
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Telephone | 704-768-1013
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Fax | 704-264-0711
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Provider Business Mailing Address
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Address Line | 1385 E GARRISON BLVD
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City | GASTONIA
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State | NC
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Zip | 28054-5127
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Country | US
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Telephone | 704-768-1013
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Fax | 704-264-0711
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Authorized Official
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Title or Position | CEO
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Name | DR. BRIAN J BOYLE
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Credential | P.T.; D.P.T.
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Telephone | 704-241-0889
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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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