Provider Demographics
NPI:1871077974
Name:SOUTH, LEANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:SOUTH
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 1:2050 SQUIRE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6271
Mailing Address - Country:US
Mailing Address - Phone:404-429-2604
Mailing Address - Fax:
Practice Address - Street 1:5825 DELMONICO DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2243
Practice Address - Country:US
Practice Address - Phone:719-257-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCP029955T2081S0010X
WAPT60887864225100000X
GAPT012866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine