Individual
MS. TRACI ANNETTE DIVELEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
10810 SANDY OAK LN, RALEIGH, NC 27614-8386
(919) 846-7147
Mailing address
4905 SUMMIT ARBOR DR APT 103, RALEIGH, NC 27612-3381
(309) 216-3591
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
160.001168
IL
225200000X
Physical Therapy Assistant
Primary
A7261
NC
Other
Enumeration date
09/14/2020
Last updated
09/14/2020
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