Healthcare Provider Details

I. General information

NPI: 1700177649
Provider Name (Legal Business Name): LEANNE APRIL HARRISON-FORBES BSCPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 NW 16TH AVE
GAINESVILLE FL
32601-4023
US

IV. Provider business mailing address

1203 NW 16TH AVE
GAINESVILLE FL
32601-4023
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-7337
  • Fax:
Mailing address:
  • Phone: 352-373-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: