Provider Demographics
NPI:1982484234
Name:GHAZAL, PAXTON DETTOR
Entity type:Individual
Prefix:
First Name:PAXTON
Middle Name:DETTOR
Last Name:GHAZAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:PAXTON
Other - Middle Name:
Other - Last Name:DETTOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-558-0076
Mailing Address - Fax:
Practice Address - Street 1:2008 MOORE RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4978
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP22562225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist