Provider Demographics
NPI:1285700542
Name:LEEDS, JENNIFER ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:LEEDS
Suffix:
Gender:F
Credentials:PT
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Other - First Name:
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Mailing Address - Street 1:1111 RONALD REAGAN PKWY
Mailing Address - Street 2:MG214
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7085
Mailing Address - Country:US
Mailing Address - Phone:317-271-3070
Mailing Address - Fax:317-217-3073
Practice Address - Street 1:1111 RONALD REAGAN PKWY
Practice Address - Street 2:MG214
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-271-3070
Practice Address - Fax:317-217-3073
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN05006009A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist