Provider Demographics
NPI:1548735830
Name:CALUNGSUD, STELLA UNABIA (PT)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:UNABIA
Last Name:CALUNGSUD
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 1:5153 HOLLY RIDGE FARM RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6105
Mailing Address - Country:US
Mailing Address - Phone:732-556-8759
Mailing Address - Fax:
Practice Address - Street 1:8200 LITCHFORD RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4231
Practice Address - Country:US
Practice Address - Phone:919-878-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty