Provider Demographics
NPI:1700458650
Name:MOORESVILLE SPORTS & PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MOORESVILLE SPORTS & PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, ATC, CMTPT
Authorized Official - Phone:704-719-7348
Mailing Address - Street 1:17217 ROYAL COURT DR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7843
Mailing Address - Country:US
Mailing Address - Phone:704-719-7348
Mailing Address - Fax:
Practice Address - Street 1:478 WILLIAMSON RD STE E
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9109
Practice Address - Country:US
Practice Address - Phone:704-696-8223
Practice Address - Fax:704-696-8231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy