Provider Demographics
NPI:1205231818
Name:RUMPH, LEKEATHA
Entity Type:Individual
Prefix:
First Name:LEKEATHA
Middle Name:
Last Name:RUMPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1552
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-1552
Mailing Address - Country:US
Mailing Address - Phone:478-956-4916
Mailing Address - Fax:478-956-0958
Practice Address - Street 1:100 HAMILTON POINTE DR.
Practice Address - Street 2:120
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008
Practice Address - Country:US
Practice Address - Phone:478-956-4916
Practice Address - Fax:478-956-0958
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist