Provider Demographics
NPI:1154748440
Name:ZHAO, LEON SI (PT)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:SI
Last Name:ZHAO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:SI
Other - Middle Name:
Other - Last Name:ZHAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 601791
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1791
Mailing Address - Country:US
Mailing Address - Phone:980-302-9740
Mailing Address - Fax:980-302-9750
Practice Address - Street 1:6324 FAIRVIEW RD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3361
Practice Address - Country:US
Practice Address - Phone:980-302-9740
Practice Address - Fax:980-302-9750
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036785225100000X
CT010028225100000X
NCP15410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist