Healthcare Provider Details

I. General information

NPI: 1588193007
Provider Name (Legal Business Name): ANSEL CLAYTON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 VANDERBILT PARK DR
ASHEVILLE NC
28803-1700
US

IV. Provider business mailing address

PO BOX 602811
CHARLOTTE NC
28260-2811
US

V. Phone/Fax

Practice location:
  • Phone: 828-255-7776
  • Fax: 828-274-5134
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP17105
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: