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NPI Code Detail

MEDICARE: JANE MARIE PEDERSEN PT

MEDICARE: JANE MARIE PEDERSEN PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4397NC
22251X0800XOrthopedic Physical Therapist4397NC
32251P0200XPediatric Physical Therapist4397NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11017POTHERBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1154371516
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE MARIE PEDERSEN PT
Provider Business Mailing Address
First Line : 308 HASSELLWOOD DR
Second Line :
City : CARY
State : NC
Zip : 27518-3013
Country : US
Telephone Number : 919-606-3086
Fax Number :
Provider Business Practice Location Address
First Line : 3000 ERWIN RD
Second Line :
City : DURHAM
State : NC
Zip : 27705-4504
Country : US
Telephone Number : 919-698-2149
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 03/26/2025

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