Provider Demographics
NPI:1407414840
Name:FABIN PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:FABIN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSI
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:FABIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:704-682-3903
Mailing Address - Street 1:1901 SUMMEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7931
Mailing Address - Country:US
Mailing Address - Phone:704-682-3903
Mailing Address - Fax:
Practice Address - Street 1:1901 SUMMEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7931
Practice Address - Country:US
Practice Address - Phone:704-682-3903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty