Provider Demographics
NPI:1396540159
Name:LECKRONE, TIMOTHY JOEL (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOEL
Last Name:LECKRONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 GERDING DR
Mailing Address - Street 2:
Mailing Address - City:WINGATE
Mailing Address - State:NC
Mailing Address - Zip Code:28174-9601
Mailing Address - Country:US
Mailing Address - Phone:704-989-6822
Mailing Address - Fax:
Practice Address - Street 1:1730 DICKERSON BLVD STE D
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2884
Practice Address - Country:US
Practice Address - Phone:704-459-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP23889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist