Healthcare Provider Details

I. General information

NPI: 1982957429
Provider Name (Legal Business Name): ALEXANDRA V LEEWRIGHT MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA VELEZ MPT

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 03/31/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 CEDAR POINT BLVD
CEDAR POINT NC
28584-8008
US

IV. Provider business mailing address

530 CEDAR POINT BLVD
CEDAR POINT NC
28584-8008
US

V. Phone/Fax

Practice location:
  • Phone: 252-393-8828
  • Fax: 252-393-7928
Mailing address:
  • Phone: 252-393-8828
  • Fax: 252-393-7928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13952
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: