Provider Demographics
NPI:1306103395
Name:AYCOTH, SUSAN KING (PTA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KING
Last Name:AYCOTH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:ANGIE
Other - Middle Name:K
Other - Last Name:AYCOTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:8845 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:STANFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:28163-5528
Mailing Address - Country:US
Mailing Address - Phone:704-888-0356
Mailing Address - Fax:
Practice Address - Street 1:8845 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:STANFIELD
Practice Address - State:NC
Practice Address - Zip Code:28163-5528
Practice Address - Country:US
Practice Address - Phone:704-888-0356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1704225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant