Healthcare Provider Details

I. General information

NPI: 1871077974
Provider Name (Legal Business Name): LEANNE SOUTH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 DELMONICO DR STE 100
COLORADO SPRINGS CO
80919-2243
US

IV. Provider business mailing address

2050 SQUIRE DR
MARIETTA GA
30066-6271
US

V. Phone/Fax

Practice location:
  • Phone: 719-257-4240
  • Fax:
Mailing address:
  • Phone: 404-429-2604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberCP029955T
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60887864
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012866
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: