MEDICARE: CLEVELAND PHYSICAL THERAPY ASSOC II

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	225200000X	Physical Therapy Assistant	9863	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114908290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND PHYSICAL THERAPY ASSOC II

Provider Business Mailing Address
First Line	:	1129 E MARION ST
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4843
Country	:	US
Telephone Number	:	704-471-0001
Fax Number	:	704-471-0004

Provider Business Practice Location Address
First Line	:	335B W COLLEGE AVE
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28152-8111
Country	:	US
Telephone Number	:	704-434-8175
Fax Number	:	704-434-8176

Authorized Official
Title or Position	:	DIRECTOR OF ADMINISTRATION
Name	:	MR. JAMES E CROWELL
Credential	:
Telephone Number	:	704-471-0001

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/22/2020

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