Healthcare Provider Details

I. General information

NPI: 1699540443
Provider Name (Legal Business Name): EMILY LEDYARD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 MAIN ST STE 5
SHALLOTTE NC
28470-4585
US

IV. Provider business mailing address

4501 MAIN ST STE 5
SHALLOTTE NC
28470-4585
US

V. Phone/Fax

Practice location:
  • Phone: 910-755-5863
  • Fax: 910-755-5864
Mailing address:
  • Phone: 910-755-5863
  • Fax: 910-755-5864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP25072
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: