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NPI Code Detail

MEDICARE: SLATER NOLAN DPT

MEDICARE: SLATER NOLAN DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist12558SC
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1336904952
Entity Type Code : Individual
Provider Name (Legal Business Name) : SLATER NOLAN DPT
Provider Business Mailing Address
First Line : 8918 BLAKENEY PROFESSIONAL DR STE 120
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-6692
Country : US
Telephone Number : 704-900-8960
Fax Number : 704-817-9523
Provider Business Practice Location Address
First Line : 857 PROMENADE WALK
Second Line :
City : FORT MILL
State : SC
Zip : 29708-6992
Country : US
Telephone Number : 803-547-1133
Fax Number : 803-543-1213
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2024
Last Update Date : 08/30/2024

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