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
1	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1861126732
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 STE 120
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6692
Country	:	US
Telephone Number	:	704-900-8960
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 JOE KNOX AVE
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-9169
Country	:	US
Telephone Number	:	704-360-2779
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	ALAN TYSON
Credential	:
Telephone Number	:	704-900-8960

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	12/11/2023

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