Provider Demographics
NPI:1225720485
Name:LEFFINGWELL, JADE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:LEFFINGWELL
Suffix:
Gender:F
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 1:1715 FRIENDSHIP CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-6920
Mailing Address - Country:US
Mailing Address - Phone:770-240-0163
Mailing Address - Fax:770-240-0163
Practice Address - Street 1:1715 FRIENDSHIP CIR STE 300
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-6920
Practice Address - Country:US
Practice Address - Phone:770-240-0163
Practice Address - Fax:770-240-0163
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist