Provider Demographics
NPI:1114412673
Name:AMODIO, LEONARD MICHAEL III (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:MICHAEL
Last Name:AMODIO
Suffix:III
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 1:168 TORONTO RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3937
Mailing Address - Country:US
Mailing Address - Phone:770-312-5135
Mailing Address - Fax:
Practice Address - Street 1:1220 W WHEELER PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6625
Practice Address - Country:US
Practice Address - Phone:706-869-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist