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General NPI Number Information
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NPI Number | 1679722201
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Entity Type | Organization
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Legal Business Name | AYRSLEY TOWN REHABILITATION, LLC
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 2064A AYRSLEY TOWN BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28273-3577
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Country | US
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Telephone | 980-939-1580
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Fax | 980-939-1128
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Provider Business Mailing Address
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Address Line | 2064A AYRSLEY TOWN BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28273-3577
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Country | US
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Telephone | 980-939-1580
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Fax | 980-939-1128
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEX GOMEZ
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Credential | DPT
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Telephone | 980-939-1580
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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 | 1235270
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License Number State | NC
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