Individual
MRS. CATHY POULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1140 SHIPYARD BLVD, WILMINGTON, NC 28412-6439
(910) 799-4199
Mailing address
3114 RANDALL PKWY STE 2, WILMINGTON, NC 28403-2590
(910) 799-4199
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1458
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
720777V
BLUE CROSS BLUE SHIELD
NC
05
—
720777V
—
NC
Enumeration date
04/12/2006
Last updated
10/09/2007
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