Healthcare Provider Details

I. General information

NPI: 1902142086
Provider Name (Legal Business Name): NICOLE CUMBEE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE BETZ

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6278 BEACH DR SW STE 114
OCEAN ISLE BEACH NC
28469-3670
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 910-579-3900
  • Fax:
Mailing address:
  • Phone: 423-682-8840
  • Fax: 423-602-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number035706-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP14625
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: