Healthcare Provider Details

I. General information

NPI: 1912811548
Provider Name (Legal Business Name): ETHAN VORKINK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 CINEMA DR STE C
STATESVILLE NC
28625-5403
US

IV. Provider business mailing address

745 BOUNDARY ST APT 1210
NEWTON NC
28658-9567
US

V. Phone/Fax

Practice location:
  • Phone: 704-746-0022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: