Healthcare Provider Details

I. General information

NPI: 1588156970
Provider Name (Legal Business Name): MARK STEPHEN LEYHE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W MALLARD CREEK CHURCH RD
CHARLOTTE NC
28262-2324
US

IV. Provider business mailing address

4601 PARK RD STE 300
CHARLOTTE NC
28209-2290
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-2108
  • Fax:
Mailing address:
  • Phone: 704-323-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2019016461
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-05958
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP20329
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: