Provider Demographics
NPI:1043091564
Name:PIEDMONT CONCIERGE PHYSICAL THERAPY
Entity type:Organization
Organization Name:PIEDMONT CONCIERGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:919-695-3784
Mailing Address - Street 1:605 PRICE AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4450
Mailing Address - Country:US
Mailing Address - Phone:919-695-3784
Mailing Address - Fax:
Practice Address - Street 1:4300 GARRETT RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3487
Practice Address - Country:US
Practice Address - Phone:919-695-3784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy