Healthcare Provider Details

I. General information

NPI: 1336599844
Provider Name (Legal Business Name): CLARA LOUISE MARTIN BACKUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLARA LOUISE MARTIN

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11312 US 15 501 N STE 403
CHAPEL HILL NC
27517
US

IV. Provider business mailing address

904 TALLYHO TRL
CHAPEL HILL NC
27516-9018
US

V. Phone/Fax

Practice location:
  • Phone: 919-619-2461
  • Fax:
Mailing address:
  • Phone: 919-619-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberP16519
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: