Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A4731 | NC |
Y | 213ES0000X | Sports Medicine | A4731 | NC |
NPI | 1255005187 |
---|---|
Provider Name | Christine Hope Lataine Dean |
First Address | Ramseur, NC 27316-8511 |
Second Address | Asheboro, NC 27203-4728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2021 |
Last Update Date | 04/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A4731 | PHYSICAL THERAPIST ASSISTANT (01) | NC |