Healthcare Provider Details

I. General information

NPI: 1891503686
Provider Name (Legal Business Name): RYAN MCFALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2024
Last Update Date: 12/25/2024
Certification Date: 12/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 MULBERRY ST
SHALLOTTE NC
28470-4471
US

IV. Provider business mailing address

917 SIMMONS AVE
SUMMERVILLE SC
29483-3667
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-8858
  • Fax:
Mailing address:
  • Phone: 540-204-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP035050A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: