Provider Demographics
NPI:1316501646
Name:ONWARD CHARLOTTE LLC
Entity type:Organization
Organization Name:ONWARD CHARLOTTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:336-467-1453
Mailing Address - Street 1:529 W SUMMIT AVE STE 1D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4400
Mailing Address - Country:US
Mailing Address - Phone:704-228-3825
Mailing Address - Fax:
Practice Address - Street 1:529 W SUMMIT AVE STE 1D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4350
Practice Address - Country:US
Practice Address - Phone:336-467-1453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty