Provider Demographics
NPI:1609472539
Name:RESURGENCE NEURO REHAB, PLLC
Entity Type:Organization
Organization Name:RESURGENCE NEURO REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:POTTER
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:585-490-9809
Mailing Address - Street 1:245 LE PHILLIP CT NE STE C
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2900
Mailing Address - Country:US
Mailing Address - Phone:704-264-0528
Mailing Address - Fax:980-326-3385
Practice Address - Street 1:245 LE PHILLIP CT NE STE C
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2900
Practice Address - Country:US
Practice Address - Phone:704-264-0528
Practice Address - Fax:980-326-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty