Individual
CHARLES A LONG
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
11 N MAIN ST, GWINNER, ND 58040-4001
(701) 678-2244
(701) 678-2210
Mailing address
11 N MAIN ST, GWINNER, ND 58040-4001
(701) 678-2244
(701) 678-2210
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
580
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51075
—
ND
Enumeration date
06/16/2006
Last updated
07/08/2007
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