Healthcare Provider Details

I. General information

NPI: 1801113717
Provider Name (Legal Business Name): TIMOTHY A LESONDAK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2010
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 SHANNON WILLOW RD SUITE 700
CHARLOTTE NC
28226-1346
US

IV. Provider business mailing address

1860 CATHEDRAL MILLS LN APT 203
ROCK HILL SC
29732-7512
US

V. Phone/Fax

Practice location:
  • Phone: 704-995-8136
  • Fax:
Mailing address:
  • Phone: 814-397-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6091
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12319
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020060
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberCP031036T
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP031036T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: