Provider Demographics
NPI:1194932871
Name:LIBERA, JOSEPH VICTOR (PT)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VICTOR
Last Name:LIBERA
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 1:209 S WILLIAMSON AVE
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9252
Mailing Address - Country:US
Mailing Address - Phone:336-684-0500
Mailing Address - Fax:336-584-0189
Practice Address - Street 1:209 S WILLIAMSON AVE
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9252
Practice Address - Country:US
Practice Address - Phone:336-684-0500
Practice Address - Fax:336-584-0189
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist