MEDICARE: CORE CONNECTION THERAPY AND WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1093468415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE CONNECTION THERAPY AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	8901 FESTIVAL WAY
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3286
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 FESTIVAL WAY
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3286
Country	:	US
Telephone Number	:	330-604-4509
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	ASHTON E HARRINGTON
Credential	:	PT, DPT
Telephone Number	:	704-302-6504

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	02/05/2022

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