Provider Demographics
NPI:1194727776
Name:PACKER, IDELLE S (PT)
Entity type:Individual
Prefix:MS
First Name:IDELLE
Middle Name:S
Last Name:PACKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 MERRILLS CHASE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8701
Mailing Address - Country:US
Mailing Address - Phone:828-329-7761
Mailing Address - Fax:828-687-0407
Practice Address - Street 1:70 WOODFIN PL
Practice Address - Street 2:WW7
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801
Practice Address - Country:US
Practice Address - Phone:828-329-7761
Practice Address - Fax:828-687-0407
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP8032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2503929COtherMEDICARE - SKYLAND PT
NC2504100OtherBODY SENSE MEDICARE
NC126WUOtherBCBS-BODY SENSE
NC2503929CMedicare ID - Type Unspecified
NC2503929BMedicare UPIN