Provider Demographics
NPI:1972691947
Name:NEZHADI, DOLORES DE LA CONCEPCION (MPT)
Entity type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:DE LA CONCEPCION
Last Name:NEZHADI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:DOLORES
Other - Middle Name:CHRISTINE
Other - Last Name:DELA CONCEPCION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1801 OLIVE CHAPEL RD
Mailing Address - Street 2:STE 3
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8586
Mailing Address - Country:US
Mailing Address - Phone:919-535-8758
Mailing Address - Fax:321-773-8154
Practice Address - Street 1:1801 OLIVE CHAPEL RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-8586
Practice Address - Country:US
Practice Address - Phone:919-296-0895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22947225100000X
NCP14823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT-22947OtherSTATE OF FL. PT LICENSE
FLPT-22947OtherSTATE OF FL. PT LICENSE