Individual
BRIAN MICHAEL BAUCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1717 SHIPYARD BLVD, SUITE 320, WILMINGTON, NC 28403-8023
(910) 791-0396
(910) 791-0818
Mailing address
1717 SHIPYARD BLVD, SUITE 320, WILMINGTON, NC 28403-8023
(910) 791-0396
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10787
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7212129
—
NC
Enumeration date
10/04/2006
Last updated
09/03/2009
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