Provider Demographics
NPI:1184718736
Name:MCCALL, SANDRA GIBSON (PTA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:GIBSON
Last Name:MCCALL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 KING RD
Mailing Address - Street 2:
Mailing Address - City:PISGAH FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:28768
Mailing Address - Country:US
Mailing Address - Phone:828-885-2908
Mailing Address - Fax:
Practice Address - Street 1:1266 ASHEVILLE HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712
Practice Address - Country:US
Practice Address - Phone:828-883-5254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1357225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1357OtherPHYSICAL THERAPY ASSISTAN