Healthcare Provider Details

I. General information

NPI: 1588123293
Provider Name (Legal Business Name): CHANNING DYSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 BARTLETT CIR
HILLSBOROUGH NC
27278-6921
US

IV. Provider business mailing address

2002 BARTLETT CIR
HILLSBOROUGH NC
27278-6921
US

V. Phone/Fax

Practice location:
  • Phone: 919-614-1923
  • Fax: 919-644-6646
Mailing address:
  • Phone: 919-614-1923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18541
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: