Provider Demographics
NPI:1336106145
Name:NEHLS, CONSTANCE BUELL (MS, PT, CLT)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:BUELL
Last Name:NEHLS
Suffix:
Gender:F
Credentials:MS, PT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 N RADNER WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-5532
Mailing Address - Country:US
Mailing Address - Phone:919-844-0396
Mailing Address - Fax:
Practice Address - Street 1:2907 BLUE RIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6423
Practice Address - Country:US
Practice Address - Phone:919-784-4696
Practice Address - Fax:919-784-4697
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5958OtherPHYSICAL THERAPY LICENSE