Healthcare Provider Details

I. General information

NPI: 1376110031
Provider Name (Legal Business Name): KENNETH RAY ALLISON III DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 11/07/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 COPPERFIELD BLVD SUITE 107
CONCORD NC
28025
US

IV. Provider business mailing address

8918 BLAKENEY PROFESSIONAL DR STE 120
CHARLOTTE NC
28277-6692
US

V. Phone/Fax

Practice location:
  • Phone: 980-777-8031
  • Fax:
Mailing address:
  • Phone: 704-900-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberP20823
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: