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General NPI Number Information
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NPI Number | 1063872646
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Entity Type | Individual
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Provider Name | JACQUELINE LOUISE DE SENGLAU PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 809 SPRINGMOOR DR
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City | RALEIGH
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State | NC
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Zip | 27615-7739
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Country | US
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Telephone | 919-848-7125
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 MORELAND AVE
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City | DURHAM
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State | NC
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Zip | 27707-1255
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Country | US
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Telephone | 443-844-2962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 10308
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16113
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License Number State | NC
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