Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251X0800X | Physical Therapist - Orthopedic | 1259603 | TX |
Y | 2251X0800X | Physical Therapist - Orthopedic | P16388 | NC |
NPI | 1053792556 |
---|---|
Provider Name | Felipe Fidalgo |
First Address | Charlotte, NC 28210-0199 |
Second Address | Concord, NC 28025-1917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 19/07/2017 |