Healthcare Provider Details

I. General information

NPI: 1043925571
Provider Name (Legal Business Name): GARRISON GRAY PEELE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 RANDOLPH RD FL 1
CHARLOTTE NC
28207-1101
US

IV. Provider business mailing address

4601 PARK RD STE 300
CHARLOTTE NC
28209-2290
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-3009
  • Fax: 704-323-3975
Mailing address:
  • Phone: 704-323-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21705
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: