Provider Demographics
NPI:1255003091
Name:NEALIS, BRITTANEY NICOLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRITTANEY
Middle Name:NICOLE
Last Name:NEALIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12703 RUSTY BLACKBIRD WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6892
Mailing Address - Country:US
Mailing Address - Phone:540-903-1337
Mailing Address - Fax:
Practice Address - Street 1:1135 STONECREST BLVD
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-6557
Practice Address - Country:US
Practice Address - Phone:803-547-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty