Healthcare Provider Details

I. General information

NPI: 1255219523
Provider Name (Legal Business Name): LAUREN JOSEPHINE STALEY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7495 HIGH MARKET ST UNIT 6
SUNSET BEACH NC
28468-4335
US

IV. Provider business mailing address

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 910-332-3828
  • Fax: 910-251-0421
Mailing address:
  • Phone: 919-220-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16839
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP24592
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054922
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: