Healthcare Provider Details

I. General information

NPI: 1265107262
Provider Name (Legal Business Name): LEANZA SIDEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 CAROLINA BEACH RD STE 100
WILMINGTON NC
28412-2366
US

IV. Provider business mailing address

423 MALLARD DR
PINEVILLE NC
28134-7561
US

V. Phone/Fax

Practice location:
  • Phone: 910-444-0020
  • Fax:
Mailing address:
  • Phone: 980-229-2604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP24270
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: