Healthcare Provider Details

I. General information

NPI: 1366423964
Provider Name (Legal Business Name): ANTOINETTE OHLSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 TUCKASEEGEE RD
CHARLOTTE NC
28208-2801
US

IV. Provider business mailing address

PO BOX 667744
CHARLOTTE NC
28266-7744
US

V. Phone/Fax

Practice location:
  • Phone: 704-392-4057
  • Fax: 704-392-4788
Mailing address:
  • Phone: 704-588-4757
  • Fax: 704-583-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6478
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: