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General NPI Number Information
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NPI Number | 1710654934
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Entity Type | Individual
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Provider Name | ERIC JAMES LEACH PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 26 MASSACHUSETTS AVE # 4510
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City | ARLINGTON
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State | MA
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Zip | 02474-8620
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Country | US
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Telephone | 617-828-5617
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Fax | 617-249-0600
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Provider Business Mailing Address
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Address Line | 26 MASSACHUSETTS AVE # 4510
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City | ARLINGTON
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State | MA
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Zip | 02474-8620
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Country | US
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Telephone | 617-828-5617
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Fax | 617-249-0600
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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 | 25620
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License Number State | MA
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