Provider Demographics
NPI:1184210635
Name:GROW PT, LLC
Entity Type:Organization
Organization Name:GROW PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:LINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, ATC, CSCS
Authorized Official - Phone:704-806-1542
Mailing Address - Street 1:2128 REMOUNT RD STE A-1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5051
Mailing Address - Country:US
Mailing Address - Phone:704-806-1542
Mailing Address - Fax:
Practice Address - Street 1:2128 REMOUNT RD STE A-1
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5051
Practice Address - Country:US
Practice Address - Phone:704-806-1542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy