Provider Demographics
NPI:1073137410
Name:ORIGIN REHABILITATION, LLC
Entity type:Organization
Organization Name:ORIGIN REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:REED
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:704-905-1333
Mailing Address - Street 1:7900 MATTHEWS MINT HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-6566
Mailing Address - Country:US
Mailing Address - Phone:704-905-1333
Mailing Address - Fax:704-565-4285
Practice Address - Street 1:7900 MATTHEWS MINT HILL RD STE 300
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-6566
Practice Address - Country:US
Practice Address - Phone:704-905-1333
Practice Address - Fax:704-565-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1194127969Medicaid