Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 4104 | NC |
N | 2251G0304X | Physical Therapist - Geriatrics | 4104 | NC |
N | 2251N0400X | Physical Therapist - Neurology | 4104 | NC |
N | 2251S0007X | Physical Therapist - Sports | 4104 | NC |
N | 2251X0800X | Physical Therapist - Orthopedic | 4104 | NC |
NPI | 1427266709 |
---|---|
Provider Name | Mr. Mark Alan Castleberry SR. |
First Address | Lexington, NC 27292-0710 |
Second Address | Lexington, NC 27292-0710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |