Provider Demographics
NPI:1710994108
Name:AIKEN, DAVID L (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:AIKEN
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 1:1100 BLYTHE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5814
Mailing Address - Country:US
Mailing Address - Phone:704-355-4370
Mailing Address - Fax:704-355-4231
Practice Address - Street 1:1106 REYNOLDS ST
Practice Address - Street 2:CUITE 200
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4350
Practice Address - Country:US
Practice Address - Phone:704-291-7755
Practice Address - Fax:704-291-7757
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC299391OtherMAMSI
NC720791KMedicaid
NY78331OtherMEDCOST
NC112029OtherWELLNESS
NC0791KOtherBCBS