Phillip Stack, ATC
Specialist/Technologist, Athletic Trainer in Charlotte, NC. Individual provider (NPI-1).
NPI number1689237471
StatusActive
Last updated in NPPESDec 16, 2021
Details
- NPI
- 1689237471
- Entity type
- Individual (NPI-1)
- Name
- Phillip Stack
- Credential
- ATC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 17, 2019
- Certification date
- Dec 16, 2021
- Last updated
- Dec 16, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 2000021342 | NC | Yes |
Practice location
900 Center Park DrCharlotte, NC 28217-2961
Phone 336-817-9315
Mailing address
1713 Seifert CirCharlotte, NC 28205-7255
Phone 336-817-9315
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