Healthcare Provider Details

I. General information

NPI: 1346358553
Provider Name (Legal Business Name): LEADER PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5039 PARK AVE SUITE 102
MEMPHIS TN
38117-5701
US

IV. Provider business mailing address

5039 PARK AVE SUITE 102
MEMPHIS TN
38117-5701
US

V. Phone/Fax

Practice location:
  • Phone: 901-818-9746
  • Fax: 901-818-9741
Mailing address:
  • Phone: 901-818-9746
  • Fax: 901-818-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANNA P. KING
Title or Position: VP/AUTHORIZED OFFICIAL
Credential: JD
Phone: 713-297-7000