MEDICARE: MS. CONSTANCE BUELL NEHLS MS, PT, CLT

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
1	225100000X	Physical Therapist	5958	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5958	OTHER	NC	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1336106145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONSTANCE BUELL NEHLS MS, PT, CLT

Provider Business Mailing Address
First Line	:	11100 N RADNER WAY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-5532
Country	:	US
Telephone Number	:	919-844-0396
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 BLUE RIDGE RD
Second Line	:	SUITE 200
City	:	RALEIGH
State	:	NC
Zip	:	27607-6423
Country	:	US
Telephone Number	:	919-784-4696
Fax Number	:	919-784-4697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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