Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1767 | NC |
NPI | 1346539194 |
---|---|
Provider Name | Mrs. Ruth Fulghum Olive |
First Address | Cary, NC 27518-1916 |
Second Address | Cary, NC 27518-1916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2011 |
Last Update Date | 01/04/2011 |