Healthcare Provider Details

I. General information

NPI: 1962087148
Provider Name (Legal Business Name): JOSEPH LIBERA PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S WILLIAMSON AVE
ELON NC
27244-9252
US

IV. Provider business mailing address

209 S WILLIAMSON AVE
ELON NC
27244-9252
US

V. Phone/Fax

Practice location:
  • Phone: 336-684-0500
  • Fax: 336-684-0500
Mailing address:
  • Phone: 336-684-0500
  • Fax: 336-684-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier85-2519943
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: DR. JOSEPH VICTOR LIBERA
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 336-684-0500