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NPI Code Detail

MEDICARE: COLLECTIVE THERAPY CORP.

MEDICARE: COLLECTIVE THERAPY CORP.
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
1225100000XPhysical Therapist
2225X00000XOccupational Therapist
3235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1396380911
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLLECTIVE THERAPY CORP.
Provider Business Mailing Address
First Line : 507 WAKEFIELD DR APT C
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-3148
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 507 WAKEFIELD DR APT C
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-3148
Country : US
Telephone Number : 919-332-3221
Fax Number :
Authorized Official
Title or Position : INCORPORATOR
Name : MR. BRIAN HURLEY
Credential : CCC-SLP
Telephone Number : 919-332-3221
Provider Enumeration Date : 11/07/2019
Last Update Date : 12/03/2019

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Directions to “COLLECTIVE THERAPY CORP. ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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