Provider Demographics
NPI:1780414607
Name:LEEDS, ERIKA MICHELLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:MICHELLE
Last Name:LEEDS
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 1:7428 ASHLEY SHORES CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7618
Mailing Address - Country:US
Mailing Address - Phone:561-313-7243
Mailing Address - Fax:
Practice Address - Street 1:601 HOUZE WAY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1478
Practice Address - Country:US
Practice Address - Phone:855-362-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist