Provider Demographics
NPI:1578539490
Name:INGLE, CHARLES C (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:C
Last Name:INGLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:GRIFTON
Mailing Address - State:NC
Mailing Address - Zip Code:28530-1387
Mailing Address - Country:US
Mailing Address - Phone:252-524-4935
Mailing Address - Fax:
Practice Address - Street 1:1610 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-2947
Practice Address - Country:US
Practice Address - Phone:252-522-1960
Practice Address - Fax:252-522-3298
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC297548OtherMAMSI
NC4524AOtherBCBS
NC724524AMedicaid
NCA7962OtherMEDCOST