Provider Demographics
NPI:1174645121
Name:LEDIS, DAVID G (MPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:LEDIS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 GREEN CAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5543
Mailing Address - Country:US
Mailing Address - Phone:561-676-0095
Mailing Address - Fax:561-795-9426
Practice Address - Street 1:8614 GREEN CAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-5543
Practice Address - Country:US
Practice Address - Phone:561-676-0095
Practice Address - Fax:561-795-9426
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist