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General NPI Number Information
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NPI Number | 1942310610
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Entity Type | Individual
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Provider Name | JOAN B. LUELLEN PT
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 607 W MCINTOSH ST
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City | SANFORD
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State | NC
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Zip | 27330-5536
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Country | US
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Telephone | 919-774-4634
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Fax | 919-776-2113
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Provider Business Mailing Address
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Address Line | 302 WESTOVER DR
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City | SANFORD
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State | NC
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Zip | 27330-8952
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Country | US
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Telephone | 919-776-7774
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1448
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License Number State | NC
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