Healthcare Provider Details

I. General information

NPI: 1467366781
Provider Name (Legal Business Name): BRENT DANIEL PURDY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10905 PROVIDENCE RD W
CHARLOTTE NC
28277-1538
US

IV. Provider business mailing address

10905 PROVIDENCE RD W
CHARLOTTE NC
28277-1538
US

V. Phone/Fax

Practice location:
  • Phone: 980-488-4000
  • Fax:
Mailing address:
  • Phone: 980-488-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number9556
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: