Provider Demographics
NPI:1477152023
Name:LEAP PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:LEAP PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:347-469-5942
Mailing Address - Street 1:9039 W BROAD ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-5842
Mailing Address - Country:US
Mailing Address - Phone:347-469-5942
Mailing Address - Fax:
Practice Address - Street 1:9039 W BROAD ST STE 5
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-5842
Practice Address - Country:US
Practice Address - Phone:347-469-5942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty