Provider Demographics
NPI:1376739391
Name:DUDA, LEYANA ROSE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LEYANA
Middle Name:ROSE
Last Name:DUDA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SADDLEMOUNT LN
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7047
Mailing Address - Country:US
Mailing Address - Phone:413-221-8349
Mailing Address - Fax:
Practice Address - Street 1:110 SUMMIT HILLS DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1532
Practice Address - Country:US
Practice Address - Phone:864-573-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4487225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty