Provider Demographics
NPI:1588226849
Name:LEAK, FREDRICK CURTIS
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:CURTIS
Last Name:LEAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MCPHERSON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-0278
Mailing Address - Country:US
Mailing Address - Phone:910-867-5141
Mailing Address - Fax:
Practice Address - Street 1:500 N MCPHERSON CHURCH RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-0278
Practice Address - Country:US
Practice Address - Phone:910-867-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-07
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC267551744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty