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General NPI Number Information
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NPI Number | 1174003610
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Entity Type | Individual
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Provider Name | KELSEY MARIE LEADER DPT
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Gender | Female
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 70 LINDSEY LN
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City | SAINT MARYS
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State | GA
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Zip | 31558-1635
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Country | US
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Telephone | 912-510-6104
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Fax | 912-882-6137
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Provider Business Mailing Address
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Address Line | 100 LINDSEY LN STE B
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City | SAINT MARYS
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State | GA
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Zip | 31558-1727
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Country | US
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Telephone | 912-510-6104
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Fax | 912-882-6137
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 33599
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT013726
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License Number State | GA
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