Provider Demographics
NPI:1053545988
Name:PHYSICAL THERAPY CENTER,LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
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:704-288-5989
Mailing Address - Street 1:1730 DICKERSON BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2884
Mailing Address - Country:US
Mailing Address - Phone:704-283-6700
Mailing Address - Fax:704-283-6713
Practice Address - Street 1:1730 DICKERSON BLVD STE D
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2884
Practice Address - Country:US
Practice Address - Phone:704-283-6700
Practice Address - Fax:704-283-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1538278189OtherPERSONAL NPI