MEDICARE: MS. SALLY TROY LIEB DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P20379	NC

General Provider Information

NPI Number	:	1912143199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SALLY TROY LIEB DPT

Provider Business Mailing Address
First Line	:	2826 RANDOLPH RD FL 2
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1359
Country	:	US
Telephone Number	:	704-366-5521
Fax Number	:

Provider Business Practice Location Address
First Line	:	2826 RANDOLPH RD FL 2
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1359
Country	:	US
Telephone Number	:	704-366-5521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	11/08/2024

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