Provider Demographics
NPI:1114409703
Name:LEPPERT, MARY THERESE (PTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THERESE
Last Name:LEPPERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:THERESE
Other - Last Name:VONDERHARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:78 DAWSON VILLAGE WAY N STE 230
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-5642
Practice Address - Country:US
Practice Address - Phone:706-265-3575
Practice Address - Fax:706-344-1207
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist