Provider Demographics
NPI:1588123293
Name:DYSON, CHANNING (DPT)
Entity type:Individual
Prefix:
First Name:CHANNING
Middle Name:
Last Name:DYSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 BARTLETT CIR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-6921
Mailing Address - Country:US
Mailing Address - Phone:919-614-1923
Mailing Address - Fax:
Practice Address - Street 1:2002 BARTLETT CIR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-6921
Practice Address - Country:US
Practice Address - Phone:919-614-1923
Practice Address - Fax:919-644-6646
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18541OtherAGENTRA