Provider Demographics
NPI:1912143199
Name:LIEB, SALLY TROY (DPT)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:TROY
Last Name:LIEB
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 RANDOLPH RD FL 2
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1359
Mailing Address - Country:US
Mailing Address - Phone:704-366-5521
Mailing Address - Fax:
Practice Address - Street 1:2826 RANDOLPH RD FL 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1359
Practice Address - Country:US
Practice Address - Phone:704-366-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20379225100000X
COPTL0014580208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist