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General NPI Number Information
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NPI Number | 1972533883
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Entity Type | Organization
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Legal Business Name | TEAM THERAPY GROUP
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 19215 PENINSULA SHORES DR
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City | CORNELIUS
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State | NC
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Zip | 28031-7579
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Country | US
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Telephone | 704-895-7343
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Fax |
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Provider Business Mailing Address
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Address Line | 19215 PENINSULA SHORES DR
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City | CORNELIUS
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State | NC
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Zip | 28031-7579
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Country | US
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Telephone | 704-895-7343
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST / OWNER
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Name | MRS. MICHELLE ROBERTSON
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Credential | P.T.
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Telephone | 704-895-7343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | P5385
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P5385
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License Number State | NC
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