Provider Demographics
NPI:1821144239
Name:WOLK, LEIGH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:
Last Name:WOLK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:LEIGH
Other - Middle Name:CABAHUG
Other - Last Name:CABASARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1020 KEITH DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2947
Mailing Address - Country:US
Mailing Address - Phone:478-224-2209
Mailing Address - Fax:
Practice Address - Street 1:1020 KEITH DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2947
Practice Address - Country:US
Practice Address - Phone:478-224-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891707800Medicaid