MEDICARE: MS. ANITA GAYLE FLEMING PHYSICAL THERAPIST

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	2954	NC
2	2251X0800X	Orthopedic Physical Therapist	P2954	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0783L	OTHER	NC	BCBSNC

General Provider Information

NPI Number	:	1790742583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANITA GAYLE FLEMING PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	4251 ARENDELL STREET
Second Line	:	SUITE B
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2871
Country	:	US
Telephone Number	:	252-808-3100
Fax Number	:	252-808-3120

Provider Business Practice Location Address
First Line	:	4251 ARENDELL STREET
Second Line	:	SUITE B
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2871
Country	:	US
Telephone Number	:	252-808-3100
Fax Number	:	252-808-3120

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	02/23/2012

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