Individual
MRS. SUSAN LANTZ FORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ITFS
Contact information
Practice address
10 PARKER LN, PINEHURST, NC 28374-7903
(910) 295-3133
Mailing address
23703 GILLIS RD, LAUREL HILL, NC 28351-9227
(910) 277-1273
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3403400
—
NC
Enumeration date
04/04/2007
Last updated
07/09/2007
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