Provider Demographics
NPI:1023723798
Name:ABUNDANT LIFE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ABUNDANT LIFE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, DN
Authorized Official - Phone:704-746-0022
Mailing Address - Street 1:133 RIDING TRL
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9165
Mailing Address - Country:US
Mailing Address - Phone:704-578-1374
Mailing Address - Fax:980-443-6070
Practice Address - Street 1:1531 CINEMA DR STE C
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-5403
Practice Address - Country:US
Practice Address - Phone:980-443-6070
Practice Address - Fax:980-443-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty