Provider Demographics
NPI:1952453326
Name:MAIRA, MARGARET L (PHD, PT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:MAIRA
Suffix:
Gender:F
Credentials:PHD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3830
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27836-1830
Mailing Address - Country:US
Mailing Address - Phone:252-321-6001
Mailing Address - Fax:252-321-6004
Practice Address - Street 1:106 E VICTORIA CT STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5708
Practice Address - Country:US
Practice Address - Phone:252-321-6001
Practice Address - Fax:252-321-6004
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB4104OtherMEDCOST
NC078E6OtherBCBS
NC7210959Medicaid