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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
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