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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 : 1437437076
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARCHITECH SPORTS AND PHYSICAL THERAPY, LLC
Provider Business Mailing Address
First Line : 1001 VAN BUREN AVE
Second Line : SUITE 3
City : INDIAN TRAIL
State : NC
Zip : 28079-5541
Country : US
Telephone Number : 704-628-6053
Fax Number : 704-628-6702
Provider Business Practice Location Address
First Line : 1001 VAN BUREN AVE
Second Line : SUITE 3
City : INDIAN TRAIL
State : NC
Zip : 28079-5541
Country : US
Telephone Number : 704-628-6053
Fax Number : 704-817-9523
Authorized Official
Title or Position : CREDENTIALING
Name : KAJA IKOH
Credential :
Telephone Number : 704-900-8960
Provider Enumeration Date : 08/01/2011
Last Update Date : 03/03/2025

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