Provider Demographics
NPI:1801113717
Name:LESONDAK, TIMOTHY A (DPT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:LESONDAK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1860 CATHEDRAL MILLS LN
Mailing Address - Street 2:APT 203
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-7512
Mailing Address - Country:US
Mailing Address - Phone:814-397-7148
Mailing Address - Fax:
Practice Address - Street 1:6911 SHANNON WILLOW RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1346
Practice Address - Country:US
Practice Address - Phone:704-995-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-01
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6091225100000X
NC12319225100000X
PAPT020060225100000X
OHCP031036T2251N0400X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology