Provider Demographics
NPI:1407004039
Name:FAILACE, LEIGH F
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:F
Last Name:FAILACE
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 1:10 WOODBRIDGE CENTER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1152
Mailing Address - Country:US
Mailing Address - Phone:732-855-0380
Mailing Address - Fax:732-855-0384
Practice Address - Street 1:10 WOODBRIDGE CENTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1152
Practice Address - Country:US
Practice Address - Phone:732-855-0380
Practice Address - Fax:732-855-0384
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA1285400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist