Provider Demographics
NPI:1902088628
Name:TRUJILLO, NEORLAN (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:NEORLAN
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 GOVERNMENT AVE SW UNIT 2828
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-5514
Mailing Address - Country:US
Mailing Address - Phone:828-781-0217
Mailing Address - Fax:
Practice Address - Street 1:231 GOVERNMENT AVE SW UNIT 2828
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28603
Practice Address - Country:US
Practice Address - Phone:828-781-0217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist