=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932827003
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAMERON BEAU DELLINGER DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2022
-----------------------------------------------------
Last Update Date | 01/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 18TH ST SE
-----------------------------------------------------
City | HICKORY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28602-1363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-485-2160
-----------------------------------------------------
Fax | 828-485-3161
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 601791
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-1791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 363-765-7058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | P21482
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------