Healthcare Provider Details

I. General information

NPI: 1528852860
Provider Name (Legal Business Name): BETHANY SIGMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 OLD MALLARD CREEK RD
CHARLOTTE NC
28262-2238
US

IV. Provider business mailing address

1429 BRYANT ST STE A
CHARLOTTE NC
28208-5201
US

V. Phone/Fax

Practice location:
  • Phone: 980-299-2048
  • Fax: 980-299-2050
Mailing address:
  • Phone: 704-919-0867
  • Fax: 704-817-8579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: