Provider Demographics
NPI:1861045072
Name:PEARSON, VANCE ALEXANDER (PTA)
Entity Type:Individual
Prefix:
First Name:VANCE
Middle Name:ALEXANDER
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PINEBLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28373-8194
Mailing Address - Country:US
Mailing Address - Phone:910-585-1089
Mailing Address - Fax:
Practice Address - Street 1:101 BRUCEWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5159
Practice Address - Country:US
Practice Address - Phone:910-692-4928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6987225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant