Individual
ALLY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
218 LAUREL CREEK CT, SPRUCE PINE, NC 28777-3134
(828) 765-7312
Mailing address
218 LAUREL CREEK CT, SPRUCE PINE, NC 28777-3134
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A5698
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A5698
NC PT BOARD
NC
Enumeration date
05/16/2019
Last updated
05/16/2019
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