Healthcare Provider Details

I. General information

NPI: 1225230709
Provider Name (Legal Business Name): VIRGINIA F. DULA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 BRIGHTLEAF DR
WHISPERING PINES NC
28327
US

IV. Provider business mailing address

212 BRIGHTLEAF DR
WHISPERING PINES NC
28327-0105
US

V. Phone/Fax

Practice location:
  • Phone: 404-520-0508
  • Fax:
Mailing address:
  • Phone: 404-520-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2305205281
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9693
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: