Provider Demographics
NPI:1124606710
Name:LEINONEN, MARY ALICE (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALICE
Last Name:LEINONEN
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 1:2905 WALNUT CIR
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-1352
Mailing Address - Country:US
Mailing Address - Phone:252-361-0799
Mailing Address - Fax:
Practice Address - Street 1:312 WARREN AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-3840
Practice Address - Country:US
Practice Address - Phone:252-523-0082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist