Individual
HOSSAM IDRISSI BOUCTEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4109 WAKE FOREST RD STE 200, RALEIGH, NC 27609-6262
(919) 322-0042
(919) 322-0041
Mailing address
504 HYANNIS DR, HOLLY SPRINGS, NC 27540-8331
(919) 633-2324
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P21044
NC
Other
Enumeration date
02/25/2022
Last updated
08/15/2023
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