Provider Demographics
NPI:1154864130
Name:ESTRADA, LEANNE (PT)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 OLDE GATE CT
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-8281
Mailing Address - Country:US
Mailing Address - Phone:904-505-8375
Mailing Address - Fax:912-244-9953
Practice Address - Street 1:33 OLDE GATE CT
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-8281
Practice Address - Country:US
Practice Address - Phone:904-505-8375
Practice Address - Fax:912-244-9953
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21587225100000X
GAPT010197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist