=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831129535
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDEL CHARLES LAMASON PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 10/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 W SALISBURY ST SUITE A
-----------------------------------------------------
City | ASHEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27203-5366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-629-6397
-----------------------------------------------------
Fax | 336-629-3969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 218 FOUST ST STE C
-----------------------------------------------------
City | ASHEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27203-5476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-625-2333
-----------------------------------------------------
Fax | 336-625-5511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5773
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------