Provider Demographics
NPI:1144288382
Name:LEISZLER, JEFF M (PT)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:M
Last Name:LEISZLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-0629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 WINCHESTER PL
Practice Address - Street 2:SUITE 100
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1550
Practice Address - Country:US
Practice Address - Phone:864-574-7282
Practice Address - Fax:864-574-7664
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11487456OtherFIRST HEALTH