Provider Demographics
NPI:1679694418
Name:AYTONA, MARIA CORAZON DULAY (PTDIPMDT)
Entity Type:Individual
Prefix:MISS
First Name:MARIA CORAZON
Middle Name:DULAY
Last Name:AYTONA
Suffix:
Gender:F
Credentials:PTDIPMDT
Other - Prefix:
Other - First Name:CORA
Other - Middle Name:DULAY
Other - Last Name:AYTONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT DIPMDT
Mailing Address - Street 1:2991 TREVOR DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-5729
Mailing Address - Country:US
Mailing Address - Phone:910-738-4554
Mailing Address - Fax:910-739-4027
Practice Address - Street 1:4895 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2162
Practice Address - Country:US
Practice Address - Phone:910-738-4554
Practice Address - Fax:910-739-4027
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist