Healthcare Provider Details

I. General information

NPI: 1770567141
Provider Name (Legal Business Name): PAUL E ASHBY JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 RANDOLPH RD LST FLOOR
CHARLOTTE NC
28207-1101
US

IV. Provider business mailing address

1915 RANDOLPH RD LST FLOOR
CHARLOTTE NC
28207-1101
US

V. Phone/Fax

Practice location:
  • Phone: 704-339-1158
  • Fax: 704-339-1447
Mailing address:
  • Phone: 704-339-1158
  • Fax: 704-339-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9360
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: