Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | P20473 | NC |
N | 2251X0800X | Physical Therapist - Orthopedic | 10807 | SC |
NPI | 1033887765 |
---|---|
Provider Name | Miss Karly Suzanne Pugh |
First Address | Charlotte, NC 28209-2290 |
Second Address | Belmont, NC 28012-5205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2021 |
Last Update Date | 27/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0397730010 | NSC # (01) | NC |