Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | ||
N | 225100000X | Physical Therapist | 4979 | NC |
NPI | 1669686077 |
---|---|
Provider Name | Mariska Charlene Truesdale |
First Address | Wilmington, NC 28409-2596 |
Second Address | Wilmington, NC 28403-6730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 13/09/2013 |