Healthcare Provider Details

I. General information

NPI: 1366250326
Provider Name (Legal Business Name): GEORGE D PAHLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10030 PARK CEDAR DR STE 101
CHARLOTTE NC
28210-8901
US

IV. Provider business mailing address

920 GERMANTOWN PIKE STE 210
PLYMOUTH MEETING PA
19462-7401
US

V. Phone/Fax

Practice location:
  • Phone: 610-292-8400
  • Fax:
Mailing address:
  • Phone: 610-292-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberOF000098
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: