Organization
INNOVATIVE PHYSICAL THERAPY SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY J DZIKOWSKI PT (OWNER/DIRECTOR)
(704) 799-9791
Entity
Organization
Contact information
Practice address
503 CANVASBACK RD, MOORESVILLE, NC 28117
(704) 799-9791
(704) 799-2687
Mailing address
503 CANVASBACK RD, MOORESVILLE, NC 28117
(704) 799-9791
(704) 799-2687
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
6107
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0149J
BCBS
NC
01
—
32633
PARTNERS
NC
01
—
5194701
CIGNA
—
01
—
6443822
UNITED HEALTHCARE
NC
05
—
7210608
—
NC
Enumeration date
07/20/2005
Last updated
08/22/2020
Update your record
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