Basic Information
| Provider Information | |||||||||
| NPI: | 1386192979 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FRIEND | ||||||||
| FirstName: | COREY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2009 NEUSE BLVD | ||||||||
| Address2: | P.O. BOX 7187 | ||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285603470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526369800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 233E BELL FORK RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285406471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102382259 | ||||||||
| FaxNumber: | 8882099322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2016 | ||||||||
| LastUpdateDate: | 10/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 16630 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 11583 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.