Provider Demographics
NPI:1790742583
Name:FLEMING, ANITA GAYLE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:GAYLE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MRS
Other - First Name:ANITA
Other - Middle Name:FLEMING
Other - Last Name:SKLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:4251 ARENDELL STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2871
Mailing Address - Country:US
Mailing Address - Phone:252-808-3100
Mailing Address - Fax:252-808-3120
Practice Address - Street 1:4251 ARENDELL STREET
Practice Address - Street 2:SUITE B
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2871
Practice Address - Country:US
Practice Address - Phone:252-808-3100
Practice Address - Fax:252-808-3120
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2954225100000X
NCP29542251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0783LOtherBCBSNC
NC2503920CMedicare UPIN
2503920BMedicare ID - Type Unspecified