Healthcare Provider Details

I. General information

NPI: 1801569785
Provider Name (Legal Business Name): LEA WOJCIECHOWSKI PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N COOL SPRING ST
FAYETTEVILLE NC
28301-5137
US

IV. Provider business mailing address

1090 ETIQUETTE HALL WAY APT 305
FAYETTEVILLE NC
28303-6026
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-4925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA7388
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: