Provider Demographics
NPI:1669108296
Name:ALSTON, GIO (PTA)
Entity type:Individual
Prefix:
First Name:GIO
Middle Name:
Last Name:ALSTON
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 1:2540 CEDAR FOREST WAY APT 301
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-1102
Mailing Address - Country:US
Mailing Address - Phone:919-618-4443
Mailing Address - Fax:
Practice Address - Street 1:4030 CARDINAL AT NORTH HILLS ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-2616
Practice Address - Country:US
Practice Address - Phone:984-538-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCXA1250598225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant