Provider Demographics
NPI:1427204890
Name:DAITOL, YOLY BETH QUIBLAT (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:YOLY BETH
Middle Name:QUIBLAT
Last Name:DAITOL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 RACCOON RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:NC
Mailing Address - Zip Code:28478-7206
Mailing Address - Country:US
Mailing Address - Phone:910-789-0837
Mailing Address - Fax:
Practice Address - Street 1:1188 RACCOON RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:NC
Practice Address - Zip Code:28478-7206
Practice Address - Country:US
Practice Address - Phone:910-789-0837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-17
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22645225100000X
NCP12103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP12103OtherPT NC LICENSE