Athelite Physical Performance Center of Lake Norman, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ATHELITE PHYSICAL PERFORMANCE CENTER OF LAKE NORMAN, LLC

Practice address

2809 Amity Hill Rd
Statesville, NC 28677-9744

Phone

(704) 768-1013

Fax

(704) 264-0711

NPI assigned

Oct 21, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brian J Boyle, P.T.; D.P.T.

Title

Ceo

Phone

(704) 241-0889

Specialties & licenses 1

Addresses

Other names 1

• AthElite PPC Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cheryl L Thomas, PT

  • Physical Therapist
  • Huntersville, NC
  • NPI 1639306830
  NPD (past)
• Sean Lane Whittaker, PT, DPT

  • Physical Therapist
  • Statesville, NC
  • NPI 1609020601
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294876800000",
    "number": "1669772802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1385 E GARRISON BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280545127",
            "telephone_number": "704-768-1013",
            "fax_number": "704-264-0711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2809 AMITY HILL RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286779744",
            "telephone_number": "704-768-1013",
            "fax_number": "704-264-0711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHELITE PHYSICAL PERFORMANCE CENTER OF LAKE NORMAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-21",
        "last_updated": "2011-01-13",
        "status": "A",
        "authorized_official_last_name": "BOYLE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-241-0889",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "P.T.; D.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AthElite PPC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brandi Hamilton Anthony, LCSW
• Temesan Dinah Anukwuem, FNP-C
• Carly Applebaum
• Jessica Arcidiacono
• Robert Adjamah Aryeetey, MD
• Tisha Augustus-Tolbert, RN, BSN
• Kathryn Aultman, COTA/L
• Aurora of Statesville, LLC
• Autumn Care of Statesville, LLC
• Autumn Corporation

• All providers in Statesville, NC
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.