Provider Demographics
NPI:1366499147
Name:DUPREE, CONNIE (PT)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:DUPREE
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 1:1130 N CHURCH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1008
Mailing Address - Country:US
Mailing Address - Phone:336-375-2300
Mailing Address - Fax:336-375-2314
Practice Address - Street 1:1130 N CHURCH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1008
Practice Address - Country:US
Practice Address - Phone:336-375-2300
Practice Address - Fax:336-375-2314
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2500052Medicare ID - Type Unspecified