Basic Information
| Provider Information | |||||||||
| NPI: | 1801092317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUBOSE | ||||||||
| FirstName: | IRVIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 LONGLEAF DR E | ||||||||
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| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283748016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102956684 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 GOSSMAN RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283872224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102952211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 9513 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.