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General NPI Number Information
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NPI Number | 1851867394
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Entity Type | Organization
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Legal Business Name | FIGHT BACK PERFORMANCE AND RECOVERY, LLC
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 1200 E MOREHEAD ST STE 190
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City | CHARLOTTE
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State | NC
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Zip | 28204-2946
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Country | US
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Telephone | 919-619-8231
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 E MOREHEAD ST STE 190
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City | CHARLOTTE
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State | NC
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Zip | 28204-2946
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Country | US
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Telephone | 980-209-0656
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Fax |
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Authorized Official
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Title or Position | CO-OWNER, PHYSICAL THERAPIST
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Name | DR. KATHERINE ALDEN EDWARDS
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Credential | DPT
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Telephone | 980-209-0656
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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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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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