Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | ||
Y | 225100000X | Physical Therapist | 11549 | NC |
N | 2251P0200X | Physical Therapist - Pediatrics | 11549 | NC |
NPI | 1770564767 |
---|---|
Provider Name | Mrs. Christina Marie Kelleigh |
First Address | Wilmington, NC 28411-9251 |
Second Address | Wilmington, NC 28403-6256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 22/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0682U | BCBS NC (01) | NC |
11230494 | CAQH (01) | |
223302 | MEDCOST (01) | NC |
35062 | OPTIMA (01) | VA |
436752 | ANTHEM BLUE CROSS (01) | |
4980093 | VIRGINIA PREMIER HEALTH (01) | |
6400313 | UNITED HEALTHCARE (01) | VA |
7384345 | AETNA (01) | |
870146 | UNITED HEALTHCARE/OPTUM HEALTH (01) | NC |
9116460 | MEDICAID DME (01) | VA |