Provider Demographics
NPI:1598207920
Name:DEDRICK, LEAH (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:DEDRICK
Suffix:
Gender:
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:GRASONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21638-1265
Mailing Address - Country:US
Mailing Address - Phone:443-618-7716
Mailing Address - Fax:
Practice Address - Street 1:116 S PINEY RD STE 204E
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2961
Practice Address - Country:US
Practice Address - Phone:443-618-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist