Provider Demographics
NPI:1174038384
Name:LEIGHTY, JAMES FREDERICK JR (PT DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FREDERICK
Last Name:LEIGHTY
Suffix:JR
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 1:104 BENNETT AVE STE 2A-2
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9423
Mailing Address - Country:US
Mailing Address - Phone:845-649-4291
Mailing Address - Fax:
Practice Address - Street 1:104 BENNETT AVE STE 2A-2
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9423
Practice Address - Country:US
Practice Address - Phone:845-649-4291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396749OtherMEDICARE