Provider Demographics
NPI:1780703454
Name:EMERY, LELAND CHRISTOPHER (PTA)
Entity type:Individual
Prefix:
First Name:LELAND
Middle Name:CHRISTOPHER
Last Name:EMERY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2332
Mailing Address - Country:US
Mailing Address - Phone:609-992-4202
Mailing Address - Fax:
Practice Address - Street 1:321 NORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2755
Practice Address - Country:US
Practice Address - Phone:215-646-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQB01778225200000X
PA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant