Provider Demographics
NPI:1114908290
Name:CLEVELAND PHYSICAL THERAPY ASSOC II
Entity Type:Organization
Organization Name:CLEVELAND PHYSICAL THERAPY ASSOC II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-471-0001
Mailing Address - Street 1:1129 E MARION ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4843
Mailing Address - Country:US
Mailing Address - Phone:704-471-0001
Mailing Address - Fax:704-471-0004
Practice Address - Street 1:335B W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-8111
Practice Address - Country:US
Practice Address - Phone:704-434-8175
Practice Address - Fax:704-434-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9863225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211706Medicaid