MEDICARE: VOLK PHYSICAL THERAPY AND SPORTS MEDICINE, 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	225100000X	Physical Therapist	7335	SC

General Provider Information

NPI Number	:	1326122094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOLK PHYSICAL THERAPY AND SPORTS MEDICINE, LLC

Provider Business Mailing Address
First Line	:	236 LE PHILLIP CT NE
Second Line	:	SUITE A
City	:	CONCORD
State	:	NC
Zip	:	28025-1917
Country	:	US
Telephone Number	:	704-707-4282
Fax Number	:	704-795-4389

Provider Business Practice Location Address
First Line	:	2000 HIGHWAY 160 W
Second Line	:	SUITE 113
City	:	FORT MILL
State	:	SC
Zip	:	29708-8548
Country	:	US
Telephone Number	:	803-802-0266
Fax Number	:	803-802-0373

Authorized Official
Title or Position	:	OWNER
Name	:	DEAN S VOLK
Credential	:	MPT
Telephone Number	:	704-707-4282

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	12/07/2016

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