Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | P16924 | NC |
NPI | 1013483015 |
---|---|
Provider Name | Dr. Cory Aaron Alcon |
First Address | Winston Salem, NC 27103-2508 |
Second Address | Winston Salem, NC 27103-2508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2018 |
Last Update Date | 17/10/2018 |