MEDICARE: TASHAN DUFF PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305210487	VA

General Provider Information

NPI Number	:	1942754791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHAN DUFF PT

Provider Business Mailing Address
First Line	:	6914 EVANTON LOCH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-8012
Country	:	US
Telephone Number	:	804-704-0368
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E MOREHEAD ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-2610
Country	:	US
Telephone Number	:	804-704-0368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2016
Last Update Date	:	05/13/2025

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