Provider Demographics
NPI:1447620729
Name:ARCHITECH SPORTS AND PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ARCHITECH SPORTS AND PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:IKOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-900-8960
Mailing Address - Street 1:13333 DORMAN RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-9336
Mailing Address - Country:US
Mailing Address - Phone:704-716-1024
Mailing Address - Fax:
Practice Address - Street 1:13333 DORMAN RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28213-8920
Practice Address - Country:US
Practice Address - Phone:704-716-1024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCHITECH SPORTS AND PHYSICAL THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-30
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
NC2487261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335865OtherMEDICARE PTAN