Provider Demographics
NPI:1669882296
Name:BECK, LAURA TEETER
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:TEETER
Last Name:BECK
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 1:35 SPRING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-7099
Mailing Address - Country:US
Mailing Address - Phone:607-279-5862
Mailing Address - Fax:910-475-1221
Practice Address - Street 1:155 ALLISON PAGE RD
Practice Address - Street 2:STE B
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-8956
Practice Address - Country:US
Practice Address - Phone:910-235-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNU000011133N00000X
NC14812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist