Provider Demographics
NPI:1386659969
Name:IRELAND, FREDERICK B (DPT)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:B
Last Name:IRELAND
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 1:1107 NEW POINTE BLVD
Mailing Address - Street 2:SUITE B-6
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4217
Mailing Address - Country:US
Mailing Address - Phone:910-399-1922
Mailing Address - Fax:866-844-3505
Practice Address - Street 1:1107 NEW POINTE BLVD
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4217
Practice Address - Country:US
Practice Address - Phone:910-399-1922
Practice Address - Fax:866-844-3505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2507110Medicare ID - Type Unspecified