Provider Demographics
NPI:1386202893
Name:CLEVELAND, ERIN LEONARD (DPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LEONARD
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8614
Mailing Address - Fax:
Practice Address - Street 1:101 CHAPMAN HILL RD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2194
Practice Address - Country:US
Practice Address - Phone:864-653-4071
Practice Address - Fax:864-653-4074
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251C2600X
SC9853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH4065Medicaid