Provider Demographics
NPI:1679751812
Name:AUDIOLOGY OF THE PINES LLC
Entity Type:Organization
Organization Name:AUDIOLOGY OF THE PINES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:910-246-6321
Mailing Address - Street 1:750 S BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5922
Mailing Address - Country:US
Mailing Address - Phone:910-997-1121
Mailing Address - Fax:
Practice Address - Street 1:127 RACQUET LN
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7626
Practice Address - Country:US
Practice Address - Phone:910-997-1121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC231H00000XOtherTAXONOMY