Provider Demographics
NPI:1891757548
Name:SENGLAR-VITALE, KELLY ANNE (PT, DPT, COMT, MDT)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANNE
Last Name:SENGLAR-VITALE
Suffix:
Gender:F
Credentials:PT, DPT, COMT, MDT
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:SENGLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, COMT, MDT
Mailing Address - Street 1:3200 NASH ST N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1231
Mailing Address - Country:US
Mailing Address - Phone:252-243-6784
Mailing Address - Fax:252-243-6782
Practice Address - Street 1:3200 NASH ST N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1231
Practice Address - Country:US
Practice Address - Phone:252-243-6784
Practice Address - Fax:252-243-6782
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10390OtherPT LICENSE