Provider Demographics
NPI:1871509430
Name:EMERSON, DEMETRA ANN (MSPT)
Entity Type:Individual
Prefix:MS
First Name:DEMETRA
Middle Name:ANN
Last Name:EMERSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6406 MCCRIMMON PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560
Mailing Address - Country:US
Mailing Address - Phone:919-467-4558
Mailing Address - Fax:
Practice Address - Street 1:6406 MCCRIMMON PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560
Practice Address - Country:US
Practice Address - Phone:919-467-4558
Practice Address - Fax:919-467-4558
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE87M80OtherACN MPN UHC
NC079WJOtherBCBS
NC828885OtherACN MPN UHC
NC2508128Medicare ID - Type Unspecified