Provider Demographics
NPI:1679916746
Name:JOY, AUDREY MAURISE (PT)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:MAURISE
Last Name:JOY
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 1:3830 WATERSIDE DR
Mailing Address - Street 2:APT 302
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-8981
Mailing Address - Country:US
Mailing Address - Phone:207-664-3361
Mailing Address - Fax:
Practice Address - Street 1:806 W EHRINGHAUS ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6935
Practice Address - Country:US
Practice Address - Phone:252-338-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist