Provider Demographics
NPI:1730644535
Name:PEGRAM, CARLA KAY (DPT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:KAY
Last Name:PEGRAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 VAN BUREN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5541
Mailing Address - Country:US
Mailing Address - Phone:252-432-3874
Mailing Address - Fax:
Practice Address - Street 1:1001 VAN BUREN AVE STE 3
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5541
Practice Address - Country:US
Practice Address - Phone:252-432-3874
Practice Address - Fax:704-628-6702
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic