Healthcare Provider Details

I. General information

NPI: 1164867446
Provider Name (Legal Business Name): JENNIFER LEIGH ARCH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5158 FOREST DR SE
COVINGTON GA
30014-3225
US

IV. Provider business mailing address

5158 FOREST DR SE
COVINGTON GA
30014-3225
US

V. Phone/Fax

Practice location:
  • Phone: 828-808-7430
  • Fax:
Mailing address:
  • Phone: 882-880-8743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5048
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT015388
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: