Individual
PHILIP JOSEPH BISSOONDIAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/ L
Contact information
Practice address
2300 GALLBERRY LN, WAXHAW, NC 28173-0161
(704) 649-4509
(704) 843-9045
Mailing address
2300 GALLBERRY LN, WAXHAW, NC 28173-0161
(704) 649-4509
(704) 843-9045
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4874
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7301563
—
NC
Enumeration date
03/27/2007
Last updated
10/05/2023
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