Provider Demographics
NPI:1639948631
Name:PULLIAM, JANIS C (LMBT, NEPT)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:C
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:LMBT, NEPT
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:
Other - Last Name:PULLIAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMBT, NEPT
Mailing Address - Street 1:5725 OLEANDER DR STE E5
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4746
Mailing Address - Country:US
Mailing Address - Phone:910-620-5765
Mailing Address - Fax:
Practice Address - Street 1:5725 OLEANDER DR STE E5
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4746
Practice Address - Country:US
Practice Address - Phone:910-620-5765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1379225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist