Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 7420 | NC |
NPI | 1003045774 |
---|---|
Provider Name | Kelly Susan Dwiggins |
First Address | China Grove, NC 28023-7696 |
Second Address | China Grove, NC 28023-7696 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2009 |
Last Update Date | 02/07/2009 |