MEDICARE: WAYNE ERIC LEISING 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	225100000X	Physical Therapist	PT008406	GA
2	225100000X	Physical Therapist	PTH4595	AL

General Provider Information

NPI Number	:	1518918929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE ERIC LEISING PT, DPT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2564
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-362-8684

Provider Business Practice Location Address
First Line	:	5009 RIVER CHASE DR
Second Line	:	STE 100C
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-7425
Country	:	US
Telephone Number	:	334-298-0650
Fax Number	:	334-298-1020

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/21/2022

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