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General NPI Number Information
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NPI Number | 1700458650
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Entity Type | Organization
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Legal Business Name | MOORESVILLE SPORTS & PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 478 WILLIAMSON RD STE E
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City | MOORESVILLE
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State | NC
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Zip | 28117-9109
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Country | US
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Telephone | 704-696-8223
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Fax | 704-696-8231
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Provider Business Mailing Address
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Address Line | 17217 ROYAL COURT DR
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City | DAVIDSON
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State | NC
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Zip | 28036-7843
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Country | US
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Telephone | 704-719-7348
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | EDWARD HELLER
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Credential | MSPT, ATC, CMTPT
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Telephone | 704-719-7348
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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 |
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License Number State |
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