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General NPI Number Information
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NPI Number | 1639392335
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Entity Type | Individual
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Provider Name | EUGENE W DESLAURIERS PT
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 1513 N HOWE ST SUITE 4
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City | SOUTHPORT
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State | NC
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Zip | 28461-2770
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Country | US
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Telephone | 910-454-8030
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 BOUGAINVILLE WAY
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City | WILMINGTON
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State | NC
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Zip | 28409-2503
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Country | US
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Telephone | 910-454-8030
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 3904
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3904
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License Number State | NC
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