Provider Demographics
NPI:1205074556
Name:LUXTON, MARY BETH M (ATC, LAT)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:M
Last Name:LUXTON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5012
Mailing Address - Country:US
Mailing Address - Phone:704-943-4500
Mailing Address - Fax:
Practice Address - Street 1:1440 CARMEL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5012
Practice Address - Country:US
Practice Address - Phone:704-943-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-24
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer