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General NPI Number Information
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NPI Number | 1780342188
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Entity Type | Organization
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Legal Business Name | THE OBSTACLE DOC PERFORMANCE TRAINING AND PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 220 DOMINION DR STE G
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City | MORRISVILLE
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State | NC
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Zip | 27560-7307
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Country | US
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Telephone | 919-230-1992
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Fax |
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Provider Business Mailing Address
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Address Line | 206 WINROCK PL
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City | DURHAM
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State | NC
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Zip | 27705-1463
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Country | US
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Telephone | 919-943-7012
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. CHRISTOPHER JOHN KOSOBUCKI
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Credential | PT, DPT, OCS, COMT
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Telephone | 919-943-7012
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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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