Healthcare Provider Details

I. General information

NPI: 1467796813
Provider Name (Legal Business Name): CYNTHIA CAMPBELL AGNER LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2012
Last Update Date: 11/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VISION DR
ASHEBORO NC
27203-3855
US

IV. Provider business mailing address

2428 HICKORY FOREST DR
ASHEBORO NC
27203-3574
US

V. Phone/Fax

Practice location:
  • Phone: 336-672-5450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: