Healthcare Provider Details

I. General information

NPI: 1053540641
Provider Name (Legal Business Name): LEARY DEAN D MCINTOSH MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 SHARIT AVE STE 101
GARDENDALE AL
35071-5090
US

IV. Provider business mailing address

919 SHARIT AVE STE 101
GARDENDALE AL
35071-5090
US

V. Phone/Fax

Practice location:
  • Phone: 954-501-1191
  • Fax:
Mailing address:
  • Phone: 954-501-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26290
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH8375
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number031431-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: