Provider Demographics
NPI:1942426937
Name:LEDFORD, MICHELLE (PT MPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:F
Credentials:PT MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 FLIPPEN TRL
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3927
Mailing Address - Country:US
Mailing Address - Phone:404-931-7248
Mailing Address - Fax:404-477-8889
Practice Address - Street 1:4261 FLIPPEN TRL
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3927
Practice Address - Country:US
Practice Address - Phone:404-931-7248
Practice Address - Fax:404-920-2154
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0006704225100000X
GAGA006704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist