MEDICARE: RICK EDWARD ST. GEORGE

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	1839	NC

General Provider Information

NPI Number	:	1952406191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICK EDWARD ST. GEORGE

Provider Business Mailing Address
First Line	:	1809 EAST BLVD
Second Line	:	STE. 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5914
Country	:	US
Telephone Number	:	704-374-1811
Fax Number	:	704-335-9958

Provider Business Practice Location Address
First Line	:	1809 EAST BLVD
Second Line	:	STE. 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5914
Country	:	US
Telephone Number	:	704-374-1811
Fax Number	:	704-335-9958

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICK EDWARD ST GEORGE
Credential	:	PT, OCS
Telephone Number	:	704-374-1811

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/22/2020

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