Provider Demographics
NPI:1922241702
Name:LEUNG STOCKDALE, GRACE (PT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LEUNG STOCKDALE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 OUTER BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1730
Mailing Address - Country:US
Mailing Address - Phone:704-350-5186
Mailing Address - Fax:
Practice Address - Street 1:190 HENDERSONVILLE RD STE 95
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2680
Practice Address - Country:US
Practice Address - Phone:704-350-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist