Healthcare Provider Details

I. General information

NPI: 1700343712
Provider Name (Legal Business Name): KALEB ALAN HILL DPT, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WOODLYN DR
YADKINVILLE NC
27055-6673
US

IV. Provider business mailing address

511 HEATHER PL
MONROE NC
28112-9550
US

V. Phone/Fax

Practice location:
  • Phone: 336-677-1800
  • Fax: 336-677-1802
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18553
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: