Provider Demographics
NPI:1619353398
Name:LEAPHART, GEREIEL MONAE
Entity Type:Individual
Prefix:
First Name:GEREIEL
Middle Name:MONAE
Last Name:LEAPHART
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 1:2734 OAK RIDGE CT
Mailing Address - Street 2:UNIT 401
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9369
Mailing Address - Country:US
Mailing Address - Phone:239-274-0692
Mailing Address - Fax:239-274-0644
Practice Address - Street 1:2734 OAK RIDGE CT
Practice Address - Street 2:UNIT 401
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9369
Practice Address - Country:US
Practice Address - Phone:239-274-0692
Practice Address - Fax:239-274-0644
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health