| Lake Norman Muay Thai Llc | |
|
107 Commons Dr Ste I Mooresville NC 28117-9262 | |
| (704) 657-1080 | |
| Not Available |
| Full Name | Lake Norman Muay Thai Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 107 Commons Dr Ste I, Mooresville, North Carolina |
| Authorized Official Name and Position | Jennifer W Smith (ACCOUNTANT) |
| Authorized Official Contact | 7045027405 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Norman Muay Thai Llc 207 Hickory Hill Rd Mooresville NC 28117-8215 Ph: (704) 657-1080 | Lake Norman Muay Thai Llc 107 Commons Dr Ste I Mooresville NC 28117-9262 Ph: (704) 657-1080 |
| NPI Number | 1336946011 |
|---|---|
| Provider Enumeration Date | 02/28/2025 |
| Last Update Date | 02/28/2025 |
| Certification Date | 02/28/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336946011 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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