Provider Demographics
NPI:1376779660
Name:REED, STEPHEN CARLYLE (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CARLYLE
Last Name:REED
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8086
Mailing Address - Country:US
Mailing Address - Phone:919-786-7434
Mailing Address - Fax:919-786-7437
Practice Address - Street 1:3200 BLUE RIDGE RD
Practice Address - Street 2:SUITE 122
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8086
Practice Address - Country:US
Practice Address - Phone:919-786-7434
Practice Address - Fax:919-786-7437
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist