Provider Demographics
NPI:1609081512
Name:LEAK, TERRY E (PTA)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:E
Last Name:LEAK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9469 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6814
Mailing Address - Country:US
Mailing Address - Phone:513-701-6100
Mailing Address - Fax:
Practice Address - Street 1:10 N LOCUST ST
Practice Address - Street 2:SUITE A
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1192
Practice Address - Country:US
Practice Address - Phone:513-523-9391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA-04123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist