Provider Demographics
NPI:1922241702
Name:LEUNG STOCKDALE, GRACE (PT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LEUNG STOCKDALE
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 1:2030 N VERMONT ST APT 301
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-2369
Mailing Address - Country:US
Mailing Address - Phone:202-255-7409
Mailing Address - Fax:
Practice Address - Street 1:2030 N VERMONT ST APT 301
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-2369
Practice Address - Country:US
Practice Address - Phone:202-255-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist