Healthcare Provider Details

I. General information

NPI: 1205740396
Provider Name (Legal Business Name): EMILY SEALEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DELTA PARK DR
SHELBY NC
28150-3575
US

IV. Provider business mailing address

8293 LAKE NORMAN PL APT 101
SHERRILLS FORD NC
28673-9488
US

V. Phone/Fax

Practice location:
  • Phone: 980-358-2571
  • Fax: 980-358-2573
Mailing address:
  • Phone: 804-868-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA8622
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: