Provider Demographics
NPI:1215221494
Name:LEARY, EMILY HARRELL (PTA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:HARRELL
Last Name:LEARY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 BIG MILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-7526
Mailing Address - Country:US
Mailing Address - Phone:252-799-9369
Mailing Address - Fax:
Practice Address - Street 1:2019 BIG MILL RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-7526
Practice Address - Country:US
Practice Address - Phone:252-799-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3488225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant