Provider Demographics
NPI:1548643323
Name:READ, JEFFREY LEONARD (PTA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEONARD
Last Name:READ
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 1:1570 N.CAROLINA RT 8 AND N CAROLINA RT 89
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:NC
Mailing Address - Zip Code:27016
Mailing Address - Country:US
Mailing Address - Phone:336-593-2831
Mailing Address - Fax:
Practice Address - Street 1:1570 N. CAROLINA RT 8 AND N. CAROLINA RT 89
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:NC
Practice Address - Zip Code:27016
Practice Address - Country:US
Practice Address - Phone:336-593-5307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4515172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker