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General NPI Number Information
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NPI Number | 1811667306
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Entity Type | Organization
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Legal Business Name | MOVEWELL PHYSICAL THERAPY
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 3120 LATROBE DR STE 210
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City | CHARLOTTE
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State | NC
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Zip | 28211-2175
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Country | US
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Telephone | 704-363-8757
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Fax |
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Provider Business Mailing Address
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Address Line | 3540 CONWAY AVE
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City | CHARLOTTE
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State | NC
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Zip | 28209-2302
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Country | US
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Telephone | 567-277-0726
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK BADENHOP
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Credential | PT, DPT, OCS, CSCS
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Telephone | 567-277-0726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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