Healthcare Provider Details

I. General information

NPI: 1295458297
Provider Name (Legal Business Name): THE NEURO THERAPIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 VANCE CRESCENT ST
ASHEVILLE NC
28806-3011
US

IV. Provider business mailing address

42 VANCE CRESCENT ST
ASHEVILLE NC
28806-3011
US

V. Phone/Fax

Practice location:
  • Phone: 904-504-3449
  • Fax:
Mailing address:
  • Phone: 904-504-3449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN ERICKSEN
Title or Position: OWNER
Credential: DPT
Phone: 904-504-3449