Provider Demographics
NPI:1417327420
Name:ARCHITECH SPORTS AND PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ARCHITECH SPORTS AND PHYSICAL THERAPY, LLC
Other - Org Name:ARCHITECH SPORTS AND PHYSICAL THERAPY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:704-609-0357
Mailing Address - Street 1:8918 BLAKENEY PROFESSIONAL DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6691
Mailing Address - Country:US
Mailing Address - Phone:704-900-8960
Mailing Address - Fax:
Practice Address - Street 1:9405 BRYANT FARMS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1642
Practice Address - Country:US
Practice Address - Phone:980-207-2707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCHITECH SPORTS AND PHYSICAL THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-02
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty