Provider Demographics
NPI:1124667480
Name:LEGGETT, JUSTIN CHARLES (PT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CHARLES
Last Name:LEGGETT
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 1:2126 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1722
Mailing Address - Country:US
Mailing Address - Phone:919-766-9022
Mailing Address - Fax:919-709-0433
Practice Address - Street 1:2126 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1722
Practice Address - Country:US
Practice Address - Phone:919-766-9022
Practice Address - Fax:919-709-0433
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist