Individual
MRS. DEIDRE S QUEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
10010 FALLS OF NEUSE RD, STE. 015, RALEIGH, NC 27614-8494
(919) 350-1508
(919) 350-1475
Mailing address
10010 FALLS OF NEUSE RD, SUITE 015, RALEIGH, NC 27614-8494
(919) 350-1508
(919) 350-1475
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10272
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079YU
BCBS OF NC
NC
Enumeration date
09/26/2006
Last updated
12/03/2013
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