Provider Demographics
NPI:1306723069
Name:LONG, LEIGHA
Entity type:Individual
Prefix:
First Name:LEIGHA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEIGHA
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:1118 CARLA JOE DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4202
Mailing Address - Country:US
Mailing Address - Phone:404-721-6222
Mailing Address - Fax:
Practice Address - Street 1:227 SANDY SPRINGS PL STE 414
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5921
Practice Address - Country:US
Practice Address - Phone:404-843-2755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist