Provider Demographics
NPI:1588621635
Name:ST GEORGE, RICK E (PT, OCS)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:E
Last Name:ST GEORGE
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3805
Mailing Address - Country:US
Mailing Address - Phone:704-607-1758
Mailing Address - Fax:
Practice Address - Street 1:1809 EAST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5879
Practice Address - Country:US
Practice Address - Phone:704-374-1811
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07932OtherBCBSNC PROVIDER #
NC250064Medicare ID - Type Unspecified