Most Relevant Information
Provider Data
| NPI Number: | 1003318338 |
| Provider Name: | MIKAILA E BOLDT DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | P22022 |
Most Important Dates
| Enumeration Date: | 03/02/2018 |
| Last Updated: | 02/14/2024 |
Provider Practice Location
580 S PAGE ST
SOUTHERN PINES
NC
283875837
Practice Location Phone/Fax
| Phone: | 7176732476 |
| Fax: | 8886456068 |
Provider Mailing Location
1327 SE TACOMA ST UNIT 122
PORTLAND
OR
972026639
Provider Mailing Phone/Fax
| Phone: | 9713619442 |
| Fax: | 8886456068 |