Individual
ETHAN MIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
445 S KINGS DR, CHARLOTTE, NC 28204-3041
(704) 384-1737
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 510-8000
(704) 510-8006
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
039525-1
NY
225100000X
Physical Therapist
Primary
P17497
NC
Other
Enumeration date
11/03/2015
Last updated
02/24/2021
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