Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | P11989 | NC |
NPI | 1003049669 |
---|---|
Provider Name | Dhiane Lumbres |
First Address | Winston-Salem, NC 27106-3040 |
Second Address | Winston Salem, NC 27106-3040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2009 |
Last Update Date | 14/10/2011 |