Provider Demographics
NPI:1346707718
Name:MANCIL, CHARLOTTE BROWN (DPT)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:BROWN
Last Name:MANCIL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:AVERY
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:115 KILDAIRE PARK DR STE 202
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8144
Practice Address - Country:US
Practice Address - Phone:919-233-9557
Practice Address - Fax:919-233-9558
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty