Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 4639 | NC |
NPI | 1083743280 |
---|---|
Provider Name | Mrs. Victoria A. Guthrie |
First Address | Chapel Hill, NC 27514-5861 |
Second Address | Durham, NC 27705-4504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
079FY | BLUE CROSS (01) | NC |
7201065 | (05) | NC |