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Individual
MRS. TRACEY NICHOLSON LAURELES
Active
Individual
MRS. TRACEY NICHOLSON LAURELES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5752
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5752
PT LICENSE
NC
01
—
62594
BCBS PROVIDER ID
NC
05
—
7200114
—
NC
Enumeration date
06/11/2006
Last updated
11/19/2014
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