Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | P13893 | NC |
NPI | 1154730992 |
---|---|
Provider Name | Dr. Niles Fleet |
First Address | Winston Salem, NC 27109-6231 |
Second Address | Winston Salem, NC 27106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2014 |
Last Update Date | 06/08/2014 |