Provider Demographics
NPI:1598790883
Name:LEA, ERIC GOLDEN (MPT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:GOLDEN
Last Name:LEA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2689
Mailing Address - Country:US
Mailing Address - Phone:770-982-0102
Mailing Address - Fax:770-982-0130
Practice Address - Street 1:1735 BUFORD HWY
Practice Address - Street 2:SUITE 310
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-1266
Practice Address - Country:US
Practice Address - Phone:770-887-0502
Practice Address - Fax:770-887-0054
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist