MEDICARE: MR. JEFFREY EUGENE LEATHERMAN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	8012	NC
2	225100000X	Physical Therapist	PTH9151	AL
3	225100000X	Physical Therapist	PT017220	GA

General Provider Information

NPI Number	:	1417064445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY EUGENE LEATHERMAN PT, DPT

Provider Business Mailing Address
First Line	:	203 NARROWS PKWY STE D
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-8649
Country	:	US
Telephone Number	:	706-315-8175
Fax Number	:	888-337-2181

Provider Business Practice Location Address
First Line	:	1519 13TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1908
Country	:	US
Telephone Number	:	706-315-8175
Fax Number	:	888-337-2181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	08/06/2024

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