Provider Demographics
NPI:1518918929
Name:LEISING, WAYNE ERIC (PT, DPT)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:ERIC
Last Name:LEISING
Suffix:
Gender:M
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 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:5009 RIVER CHASE DR
Practice Address - Street 2:STE 100C
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7425
Practice Address - Country:US
Practice Address - Phone:334-298-0650
Practice Address - Fax:334-298-1020
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008406225100000X
ALPTH4595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051529693LEIMedicare ID - Type UnspecifiedINDIVIDUAL