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General NPI Number Information
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NPI Number | 1134929581
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Entity Type | Individual
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Provider Name | MARCUS A LEACH PT
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Gender | Male
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 2601 FOREST DR
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City | COLUMBIA
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State | SC
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Zip | 29204-2363
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Country | US
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Telephone | 803-256-4983
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Fax |
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Provider Business Mailing Address
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Address Line | 108 LEAMINGTON WAY
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City | IRMO
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State | SC
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Zip | 29063-8258
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Country | US
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Telephone | 803-960-6885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 2755
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License Number State | SC
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