Provider Demographics
NPI:1831750934
Name:LEPOTH DENIYAGE, ANURADHIKA ISHARA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANURADHIKA
Middle Name:ISHARA
Last Name:LEPOTH DENIYAGE
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 1:6119 DELTONA BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1011
Mailing Address - Country:US
Mailing Address - Phone:352-592-9559
Mailing Address - Fax:352-592-9921
Practice Address - Street 1:6119 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1011
Practice Address - Country:US
Practice Address - Phone:352-592-9559
Practice Address - Fax:352-592-9921
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027716225100000X
GAPT014504225100000X
FLPT34563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist