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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 : 1417327420
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
Second Line : SUITE 120
City : CHARLOTTE
State : NC
Zip : 28277-6691
Country : US
Telephone Number : 704-900-8960
Fax Number :
Provider Business Practice Location Address
First Line : 9405 BRYANT FARMS RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-1642
Country : US
Telephone Number : 980-207-2707
Fax Number :
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : KAJA IKOH
Credential :
Telephone Number : 704-900-8960
Provider Enumeration Date : 10/02/2015
Last Update Date : 03/03/2025

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

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