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NPI Code Detail

MEDICARE: MRS. LAURA E WELLMON MPT

MEDICARE: MRS. LAURA E WELLMON MPT
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 Therapist9863NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1079MKOTHERNCBC/BS

General Provider Information

NPI Number : 1194801936
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA E WELLMON MPT
Provider Business Mailing Address
First Line : 1129 E MARION ST
Second Line :
City : SHELBY
State : NC
Zip : 28150-4843
Country : US
Telephone Number : 704-471-0001
Fax Number : 704-471-0004
Provider Business Practice Location Address
First Line : 1129 E MARION ST
Second Line :
City : SHELBY
State : NC
Zip : 28150-4843
Country : US
Telephone Number : 704-471-0001
Fax Number : 704-471-0004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. LAURA E WELLMON MPT” Practice Location

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