Provider Demographics
NPI:1326122094
Name:VOLK PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:VOLK PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:VOLK
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:704-707-4282
Mailing Address - Street 1:236 LE PHILLIP CT NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1917
Mailing Address - Country:US
Mailing Address - Phone:704-707-4282
Mailing Address - Fax:704-795-4389
Practice Address - Street 1:2000 HIGHWAY 160 W
Practice Address - Street 2:SUITE 113
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8548
Practice Address - Country:US
Practice Address - Phone:803-802-0266
Practice Address - Fax:803-802-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8115Medicare PIN