Provider Demographics
NPI:1427075886
Name:WIEDMEYER-DAVIS, KELLEY S (MS PT)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:S
Last Name:WIEDMEYER-DAVIS
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3701 NW CARY PARKWAY
Mailing Address - Street 2:SUITE 301 DUNN PHYSICAL THERAPY
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513
Mailing Address - Country:US
Mailing Address - Phone:919-388-0111
Mailing Address - Fax:919-388-8668
Practice Address - Street 1:3701 NW CARY PARKWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513
Practice Address - Country:US
Practice Address - Phone:919-388-0111
Practice Address - Fax:919-388-8668
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC7630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6698931OtherGHI
NC5102400OtherAETNA PPO
NC0784QOtherBCBS
NC2209325OtherAETNA HMO
NC6698931OtherGHI