Provider Demographics
NPI:1952741167
Name:HEBERT, LEYNA (MS, ATC)
Entity Type:Individual
Prefix:
First Name:LEYNA
Middle Name:
Last Name:HEBERT
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13245 REESE BLVD W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6307
Mailing Address - Country:US
Mailing Address - Phone:704-316-5096
Mailing Address - Fax:
Practice Address - Street 1:13245 REESE BLVD W
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6307
Practice Address - Country:US
Practice Address - Phone:704-316-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-30602255A2300X
OHAT29142255A2300X
IL096.0035722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer