Registry details
Type
Individual
Primary specialty
Physical Therapist
Enumerated
May 7, 2010
License(s)
CP043278T (GA), PT12430 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 5727 PROSPERITY CROSSING DR STE 1400 | Charlotte, NC 28269-5604 | 704-863-9970 |
| MAILING | 9616 HARRIS GLEN DR | Charlotte, NC 28269-0422 | 704-616-1300 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.