Provider Demographics
NPI:1861934010
Name:PHYSICAL THERAPY CENTER TWO, LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY CENTER TWO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:KOOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:704-502-9205
Mailing Address - Street 1:1730 DICKERSON BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2885
Mailing Address - Country:US
Mailing Address - Phone:704-283-6700
Mailing Address - Fax:704-283-6713
Practice Address - Street 1:2400 SOUTH BLVD.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203
Practice Address - Country:US
Practice Address - Phone:704-283-6700
Practice Address - Fax:704-283-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP9417261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy