Provider Demographics
NPI:1700356169
Name:VENTRIGLIA, LEANN MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:MICHELLE
Last Name:VENTRIGLIA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1017 FORDING ISLAND RD STE F101
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4211
Practice Address - Country:US
Practice Address - Phone:843-815-2563
Practice Address - Fax:843-815-2562
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9451225100000X
GAPT013757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist