Provider Demographics
NPI:1780085803
Name:LEIBFRTIZ, GINGER (DPT)
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:
Last Name:LEIBFRTIZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:DOBIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11957 S NOELLE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5790
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11957 S NOELLE RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-5790
Practice Address - Country:US
Practice Address - Phone:801-501-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9077828-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist