Provider Demographics
NPI:1083498067
Name:ULTIMATE REHABILITATION AND WELLNESS LLC
Entity Type:Organization
Organization Name:ULTIMATE REHABILITATION AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:OLUEBUBE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NDUKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:862-237-2457
Mailing Address - Street 1:1441 HEATHERS MIST AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 E 27TH STREET
Practice Address - Street 2:UNIT 103
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206
Practice Address - Country:US
Practice Address - Phone:704-565-9513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty