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NPI Code Detail

MEDICARE: KENDALL NICOLE SHALLEY DPT

MEDICARE: KENDALL NICOLE SHALLEY DPT
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 TherapistP14428NC

General Provider Information

NPI Number : 1386070928
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDALL NICOLE SHALLEY DPT
Provider Business Mailing Address
First Line : 1721 ALLENS LN
Second Line : STE 101
City : WILMINGTON
State : NC
Zip : 28403-3662
Country : US
Telephone Number : 910-256-4442
Fax Number : 910-256-4443
Provider Business Practice Location Address
First Line : 1721 ALLENS LN
Second Line : STE 101
City : WILMINGTON
State : NC
Zip : 28403-3662
Country : US
Telephone Number : 910-256-4442
Fax Number : 910-256-4443
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2013
Last Update Date : 01/06/2022

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Directions to “ KENDALL NICOLE SHALLEY DPT” Practice Location

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