Provider Demographics
NPI:1831106152
Name:MODLIN, PAITRA M (PT)
Entity Type:Individual
Prefix:
First Name:PAITRA
Middle Name:M
Last Name:MODLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 BEATTY DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-2715
Mailing Address - Country:US
Mailing Address - Phone:704-512-3391
Mailing Address - Fax:704-512-3487
Practice Address - Street 1:275 BEATTY DR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-2715
Practice Address - Country:US
Practice Address - Phone:704-512-3391
Practice Address - Fax:704-512-3487
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC112056OtherWELLNESS
NC59948OtherBCBS
NC78429OtherMEDCOST
NC7259948Medicaid
NC295464OtherMAMSI