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NPI Code Detail

MEDICARE: QUEEN CITY THERAPY, PLLC

MEDICARE: QUEEN CITY THERAPY, PLLC
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
1224ZF0002XFeeding, Eating & Swallowing Occupational Therapy Assistant
2225100000XPhysical Therapist
32251P0200XPediatric Physical Therapist
4225XP0200XPediatric Occupational Therapist
5235Z00000XSpeech-Language Pathologist
6225X00000XOccupational Therapist

General Provider Information

NPI Number : 1154813681
Entity Type Code : Organization
Provider Name (Legal Business Name) : QUEEN CITY THERAPY, PLLC
Provider Business Mailing Address
First Line : 204 WOOD DUCK LOOP
Second Line :
City : MOORESVILLE
State : NC
Zip : 28117-8136
Country : US
Telephone Number : 336-596-5112
Fax Number :
Provider Business Practice Location Address
First Line : 5113 PIPER STATION DR STE 103
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-6690
Country : US
Telephone Number : 704-752-1616
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : NICHOLAS ANDREW MCDANIEL
Credential :
Telephone Number : 704-752-1616
Provider Enumeration Date : 05/31/2018
Last Update Date : 04/16/2025

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Directions to “QUEEN CITY THERAPY, PLLC ” Practice Location

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