Healthcare Provider Details

I. General information

NPI: 1891911434
Provider Name (Legal Business Name): SUSAN EROSSY ESPER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10043 DOMINION VILLAGE DR
CHARLOTTE NC
28269-7905
US

IV. Provider business mailing address

10043 DOMINION VILLAGE DR
CHARLOTTE NC
28269-7905
US

V. Phone/Fax

Practice location:
  • Phone: 704-766-1553
  • Fax: 704-766-1554
Mailing address:
  • Phone: 704-766-1553
  • Fax: 704-766-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10569
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: