Provider Demographics
NPI:1073058533
Name:BASILE, CLAUDIA ANN (PT)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:ANN
Last Name:BASILE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 SLATER WAY
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9453
Mailing Address - Country:US
Mailing Address - Phone:585-350-9690
Mailing Address - Fax:
Practice Address - Street 1:1113 SLATER WAY
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9453
Practice Address - Country:US
Practice Address - Phone:585-350-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist