Provider Demographics
NPI:1356998595
Name:MOGENSEN, NICOLE
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:MOGENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 VALLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-3324
Mailing Address - Country:US
Mailing Address - Phone:704-576-8619
Mailing Address - Fax:
Practice Address - Street 1:3000 GALLOWAY RDG
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-8639
Practice Address - Country:US
Practice Address - Phone:919-542-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist