Provider Demographics
NPI:1417064445
Name:LEATHERMAN, JEFFREY EUGENE (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:EUGENE
Last Name:LEATHERMAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 NARROWS PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8649
Mailing Address - Country:US
Mailing Address - Phone:706-315-8175
Mailing Address - Fax:888-337-2181
Practice Address - Street 1:1519 13TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1908
Practice Address - Country:US
Practice Address - Phone:706-315-8175
Practice Address - Fax:888-337-2181
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8012174400000X
ALPTH9151225100000X
GAPT017220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist