Provider Demographics
NPI:1316182470
Name:PRO FIT REHAB OF CHARLOTTE PA
Entity Type:Organization
Organization Name:PRO FIT REHAB OF CHARLOTTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:ASHENFARB
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MPT
Authorized Official - Phone:704-971-9194
Mailing Address - Street 1:2315 W ARBORS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2639
Mailing Address - Country:US
Mailing Address - Phone:704-971-9194
Mailing Address - Fax:
Practice Address - Street 1:2315 W ARBORS DR STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2639
Practice Address - Country:US
Practice Address - Phone:704-971-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3395111N00000X
NC10026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty