Organization
CHARLOTTE SPORTS PERFORMANCE AND REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA WATTERSON D.C (OWENER)
(980) 237-4016
Entity
Organization
Contact information
Practice address
2935 PROVIDENCE RD, SUITE 204, CHARLOTTE, NC 28211-2750
(980) 237-4016
(866) 430-9402
Mailing address
2935 PROVIDENCE RD, SUITE 204, CHARLOTTE, NC 28211-2750
(980) 237-4016
(866) 430-9402
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4207
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NC4419B961
MEDICARE PTAN
NC
Enumeration date
07/10/2015
Last updated
07/10/2015
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