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General NPI Number Information
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NPI Number | 1396492443
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Entity Type | Individual
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Provider Name | JEANNIE H LEDFORD PTA
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Gender | Female
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 2745 EXECUTIVE PARK NW
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City | CLEVELAND
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State | TN
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Zip | 37312-2723
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Country | US
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Telephone | 423-479-8899
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Fax |
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Provider Business Mailing Address
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Address Line | 155 CHETOLA DR NE
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City | CLEVELAND
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State | TN
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Zip | 37323-5361
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Country | US
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Telephone | 423-322-4181
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2769
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License Number State |
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