Provider Demographics
NPI:1851434732
Name:LEIRO, BETH MILLER (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:MILLER
Last Name:LEIRO
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 1:401 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-3019
Mailing Address - Country:US
Mailing Address - Phone:919-929-3522
Mailing Address - Fax:919-929-3522
Practice Address - Street 1:401 HOLLY LN
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-3019
Practice Address - Country:US
Practice Address - Phone:919-929-3522
Practice Address - Fax:919-929-3522
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38652251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC720783AMedicaid