Basic Information
| Provider Information | |||||||||
| NPI: | 1134229669 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPORTS & MORE PHYSICAL THERAPY, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ACCESS PHYSICAL THERAPY & WELLNESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 MAYBROOK RD STE D | ||||||||
| Address2: | |||||||||
| City: | CAMPBELL HALL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109162741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456364344 | ||||||||
| FaxNumber: | 8456364355 | ||||||||
| Practice Location | |||||||||
| Address1: | 8300 HEALTH PARK | ||||||||
| Address2: | SUITE 127 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276154731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198456160 | ||||||||
| FaxNumber: | 9198456188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2006 | ||||||||
| LastUpdateDate: | 10/22/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ALBANESE | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8456364344 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 2251X0800X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 013VF | 01 | NC | BCBS OF NC | OTHER |