Provider Demographics
NPI:1982918777
Name:WOMACK, LEIGH KRISTEN
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:KRISTEN
Last Name:WOMACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:
Other - Last Name:BRAZEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:551 RIVERHILL CIR
Mailing Address - Street 2:APT 516
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-8156
Mailing Address - Country:US
Mailing Address - Phone:803-767-2650
Mailing Address - Fax:
Practice Address - Street 1:115 ATRIUM WAY
Practice Address - Street 2:SUITE 232
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6371
Practice Address - Country:US
Practice Address - Phone:803-788-8484
Practice Address - Fax:803-788-8499
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist