Provider Demographics
NPI:1821396557
Name:FULL MOTION PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:FULL MOTION PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:980-224-8191
Mailing Address - Street 1:5113 PIPER STATION DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6689
Mailing Address - Country:US
Mailing Address - Phone:980-224-8191
Mailing Address - Fax:980-224-8194
Practice Address - Street 1:5113 PIPER STATION DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6689
Practice Address - Country:US
Practice Address - Phone:980-224-8191
Practice Address - Fax:980-224-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11833261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy