Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 3120 | NC |
NPI | 1326307844 |
---|---|
Provider Name | Stacey Reid |
First Address | Raleigh, NC 27612-3812 |
Second Address | Raleigh, NC 27612-3822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2012 |
Last Update Date | 04/05/2012 |