Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 14122 | NC |
N | 2251P0200X | Physical Therapist - Pediatrics | P14122 | NC |
NPI | 1134468499 |
---|---|
Provider Name | Nicole Grates |
First Address | Aberdeen, NC 28315-3671 |
Second Address | Fayetteville, NC 28304-4450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2013 |
Last Update Date | 15/07/2013 |