Individual
CARLIE DESJARDINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
10102 S MAIN ST STE S, ARCHDALE, NC 27263-3183
(336) 307-3015
(336) 307-3004
Mailing address
10102 S MAIN ST STE S, ARCHDALE, NC 27263-3183
(336) 307-3015
(336) 307-3004
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
17324
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P17324
NC STATE LICENSE
NC
Enumeration date
08/04/2017
Last updated
05/04/2021
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