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NPI Code Detail

MEDICARE: MRS. TRACEY NICHOLSON LAURELES PT

MEDICARE: MRS. TRACEY NICHOLSON LAURELES PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5752NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
162594OTHERNCBCBS PROVIDER ID
25752OTHERNCPT LICENSE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134161599
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACEY NICHOLSON LAURELES PT
Provider Business Mailing Address
First Line : 1613 WALNUT ST
Second Line :
City : CARY
State : NC
Zip : 27511-5928
Country : US
Telephone Number : 919-535-8758
Fax Number :
Provider Business Practice Location Address
First Line : 4251 LEGION ROAD
Second Line :
City : HOPE MILLS
State : NC
Zip : 28348-1937
Country : US
Telephone Number : 910-429-0600
Fax Number : 910-429-0602
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 11/19/2014

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