Healthcare Provider Details

I. General information

NPI: 1609171958
Provider Name (Legal Business Name): CANTON PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 MAIN ST
CANTON NC
28716-4326
US

IV. Provider business mailing address

PO BOX 1033
CANTON NC
28716-1033
US

V. Phone/Fax

Practice location:
  • Phone: 828-235-9500
  • Fax: 828-235-9508
Mailing address:
  • Phone: 828-235-9500
  • Fax: 828-235-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: TAMMIE PHILLIPS
Title or Position: MANAGER
Credential: PTA
Phone: 828-235-9500