Organization
ACTIVADE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH CORCORAN PT (CEO)
(704) 839-2019
Entity
Organization
Contact information
Practice address
809 WOODRUFF PL, CHARLOTTE, NC 28208-4553
(704) 839-2019
Mailing address
809 WOODRUFF PL, CHARLOTTE, NC 28208-4553
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
01/13/2023
Last updated
01/13/2023
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