Provider Demographics
NPI:1437193778
Name:THEUERKORN, LEIA (DPT)
Entity Type:Individual
Prefix:
First Name:LEIA
Middle Name:
Last Name:THEUERKORN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15294
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28813-0294
Mailing Address - Country:US
Mailing Address - Phone:828-665-0442
Mailing Address - Fax:828-665-0412
Practice Address - Street 1:357 SANFORD DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-2555
Practice Address - Country:US
Practice Address - Phone:828-665-0442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078XEOtherBC/BS
NC9344OtherNC LICENSE
NC2509219AMedicare PIN