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General NPI Number Information
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NPI Number | 1104149491
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Entity Type | Individual
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Provider Name | JILL PAXTON STUBBS MPT
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Gender | Female
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 725 PROVIDENCE RD SUITE 205
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City | CHARLOTTE
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State | NC
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Zip | 28207-2370
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Country | US
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Telephone | 704-377-0020
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Fax | 704-342-3393
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Provider Business Mailing Address
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Address Line | 725 PROVIDENCE RD SUITE 205
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City | CHARLOTTE
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State | NC
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Zip | 28207-2370
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Country | US
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Telephone | 704-377-0020
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Fax | 704-342-3393
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4193
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License Number State | NC
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