Healthcare Provider Details

I. General information

NPI: 1043226616
Provider Name (Legal Business Name): LEIGH ANN CALDWELL MBA, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 PONDSIDE DRIVE
WINGATE NC
28174-0165
US

IV. Provider business mailing address

909 PONDSIDE DR PO BOX 5002
WINGATE NC
28174-9683
US

V. Phone/Fax

Practice location:
  • Phone: 704-233-8165
  • Fax: 704-233-8295
Mailing address:
  • Phone: 704-363-8622
  • Fax: 704-233-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number71
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: