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NPI Code Detail

MEDICARE: ARCHITECH SPORTS AND PHYSICAL THERAPY, LLC

MEDICARE: ARCHITECH SPORTS AND PHYSICAL THERAPY, 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
1261QP2000XPhysical Therapy Clinic/Center
22251X0800XOrthopedic Physical Therapist

General Provider Information

NPI Number : 1134894389
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARCHITECH SPORTS AND PHYSICAL THERAPY, LLC
Provider Business Mailing Address
First Line : 8918 BLAKENEY PROFESSIONAL DR STE 120
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-6692
Country : US
Telephone Number : 704-900-8960
Fax Number :
Provider Business Practice Location Address
First Line : 857 PROMENADE WALK
Second Line :
City : FORT MILL
State : SC
Zip : 29708-6992
Country : US
Telephone Number : 803-547-1133
Fax Number :
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : KAJA IKOH
Credential :
Telephone Number : 704-900-8960
Provider Enumeration Date : 08/10/2021
Last Update Date : 02/19/2025

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Directions to “ARCHITECH SPORTS AND PHYSICAL THERAPY, LLC ” Practice Location

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