MBODY PHYSICAL THERAPY, LLC (NPI# 1831571900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831571900 |
| Entity Type | Organization |
| Organization Name | MBODY PHYSICAL THERAPY, LLC |
| Other Organization Name | MBODY PHYSICAL THERAPY |
| Practice Address |
5200 Park Road Suite 235 Charlotte NC 28209-3651 |
| Practice Telephone | 9802884646 |
| Mailing Telephone | 9802884646 |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2015-06-25 |
| Authorized Official Name | MRS. LISA MARIE VANDER BLOOMER (OWNER / PHYSICAL THERAPIST) |
| Authorized Official Telephone | 9802884646 |
| Authorized Official Credential | PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
14338 | NC | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | MEDICARE PTAN | Q44318A | 01 |
| Other Name | Type Code |
|---|---|
| MBody Physical Therapy | Doing Business As Name - Organization |
| Street Address |
5200 PARK ROAD SUITE 235 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28209-3651 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104022979 | Homecare Link, LLC | Home Health | 5200 Park Road, Suite 131, Charlotte, NC 28209-3749 | 2007-06-26 |
| 1629608443 | Crown Counseling & Consulting, Pllc | Clinic/Center | 5200 Park Road, Suite 213-a, Charlotte, NC 28209 | 2020-01-21 |
| 1881939601 | Jeanetta L. Garrison | Social Worker | 5200 Park Road, Suite 213, Charlotte, NC 28209 | 2012-12-05 |
| 1801027719 | Alisha Cooper | Counselor | 5200 Park Road, 131, Charlotte, NC 28209-3650 | 2009-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194382200 | Christopher Joseph Malara | Occupational Therapy Assistant | 3600 Park Rd, Charlotte, 28209, Nc, Charlotte, NC 28209 | 2019-05-23 |
| 1982187571 | Elizabeth Black Smith | Dietitian, Registered | 5821 Fairview Road, Suite 216, Charlotte, NC 28209 | 2018-09-11 |
| 1235611690 | Shearer Counseling Services Pllc | Counselor | 5200 Park Road Ste 200-3, Charlotte, NC 28209 | 2018-09-02 |
| 1942796396 | Wade Medical Transportation Services, LLC | Non-emergency Medical Transport (VAN) | 4400 Park Rd Unit 315, Charlotte, NC 28209 | 2018-07-09 |
| 1750803672 | Stephanie Rindner | Behavior Technician | 716 Marsh Road, Charlotte, NC 28209 | 2017-07-12 |
| 1861939621 | Carolinas Healthcare System | General Acute Care Hospital | 3329 Weston St, Charlotte, NC 28209 | 2017-01-31 |
| 1275943011 | Cameron Cunningham | Anesthesiology | 1515 Mockingbird Ln Ste 680, Charlotte, NC 28209 | 2014-05-02 |
| 1013299205 | Digital Ultrasound Associates | Spec/Tech, Cardiovascular | 4450 South Blvd Suite 4, Charlotte, NC 28209 | 2011-09-13 |
| 1801117676 | Rosemary Nmi Lucas | Physical Therapist | 2910 Selwyn Ave #359, Charlotte, NC 28209 | 2010-06-16 |
| 1194049767 | Frances Massey Harley | Speech-Language Pathologist | 715 Hartford Avenue, Sedgefield Elementary School, Charlotte, NC 28209 | 2010-03-25 |
| Find all providers in zip 28209 | ||||
| Taxonomy Code | 2251X0800X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Orthopedic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679032866 | David James Lawton | Physical Therapist | 101 E W T Harris Blvd Ste 5001, Charlotte, NC 28262-3574 | 2019-03-18 |
| 1396263620 | Daniel Steele | Physical Therapist | 7825 Ballantyne Commons Pkwy Ste 210, Charlotte, NC 28277-3729 | 2017-09-07 |
| 1831546993 | Michael Crinion | Physical Therapist | 8918 Blakeney Professional Dr Ste 120, Charlotte, NC 28277-6692 | 2016-05-18 |
| 1659741528 | Valerie Ashburn | Physical Therapist | 2630 E 7th St Ste 206, Charlotte, NC 28204-4319 | 2015-10-04 |
| 1013141647 | Melissa Rose Dupree | Physical Therapist | 2064 Ayrsley Town Blvd Unit A, Charlotte, NC 28273-4221 | 2009-05-11 |
| 1255310793 | Thomas S Campion | Physical Therapist | 3135 Springbank Ln, Suite 220, Charlotte, NC 28226-3360 | 2006-01-12 |
| 1326022344 | Carol Myrtle Green | Physical Therapist | 3541 Randolph Rd, Ste 100w, Charlotte, NC 28211-1082 | 2005-12-02 |
| 1295719425 | Jason Arthur Mcdowell | Physical Therapist | 4421 Sharon Rd Ste 100, Charlotte, NC 28211-5585 | 2005-12-01 |
| 1548244908 | Alan D Tyson | Physical Therapist | 8918 Blakeney Professional Dr, Suite 120, Charlotte, NC 28277-6691 | 2005-11-30 |
| 1881677375 | Jennifer Sue Kane | Physical Therapist | 5960 Fairview Rd, Suite 250, Charlotte, NC 28210-3102 | 2005-11-29 |
| Find all providers in CHARLOTTE | ||||
Please comment or provide details below to improve the information on MBODY PHYSICAL THERAPY, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.