Provider Demographics
NPI:1679148787
Name:ASCANIO PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ASCANIO PHYSICAL THERAPY
Other - Org Name:HEALTHY BODY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASCANIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:704-495-1097
Mailing Address - Street 1:19607 W CATAWBA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4042
Mailing Address - Country:US
Mailing Address - Phone:704-625-6191
Mailing Address - Fax:705-896-8075
Practice Address - Street 1:19607 W CATAWBA AVE STE 102
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4042
Practice Address - Country:US
Practice Address - Phone:704-625-6191
Practice Address - Fax:705-896-8075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy