Organization
REVIVE NEURORECOVERY CENTER CLT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY CLARK DPT (OWNER)
(704) 900-3674
Entity
Organization
Contact information
Practice address
3463 HIGHWAY 21 STE 112, FORT MILL, SC 29715-7210
(704) 900-3674
Mailing address
3463 HIGHWAY 21 STE 112, FORT MILL, SC 29715-7210
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
08/11/2022
Last updated
02/25/2024
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