Provider Demographics
NPI:1821283698
Name:NETTLES, CHUCK EDWARD (PT)
Entity Type:Individual
Prefix:
First Name:CHUCK
Middle Name:EDWARD
Last Name:NETTLES
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:262 LEROY GEORGE DR
Mailing Address - Street 2:HAYWOOD REGIONAL MEDICAL CENTER
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-7430
Mailing Address - Country:US
Mailing Address - Phone:828-452-8073
Mailing Address - Fax:828-452-8072
Practice Address - Street 1:262 LEROY GEORGE DR
Practice Address - Street 2:HAYWOOD REGIONAL MEDICAL CENTER
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7430
Practice Address - Country:US
Practice Address - Phone:828-452-8073
Practice Address - Fax:828-452-8072
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC3103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist