Provider Demographics
NPI:1780460865
Name:LECLAIR, KORBIN A (DPT)
Entity type:Individual
Prefix:
First Name:KORBIN
Middle Name:A
Last Name:LECLAIR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 DAVIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7009
Mailing Address - Country:US
Mailing Address - Phone:540-552-5100
Mailing Address - Fax:540-552-5700
Practice Address - Street 1:108 KNOTBREAK RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5414
Practice Address - Country:US
Practice Address - Phone:540-685-0168
Practice Address - Fax:540-685-0169
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist