Provider Demographics
NPI:1679974661
Name:FORLINES, LEAH M (DPT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:FORLINES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1575 HIGHWAY 34 E
Mailing Address - Street 2:NEWNAN
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2401
Mailing Address - Country:US
Mailing Address - Phone:770-252-5279
Mailing Address - Fax:770-252-9940
Practice Address - Street 1:1575 HIGHWAY 34 E
Practice Address - Street 2:NEWNAN
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2401
Practice Address - Country:US
Practice Address - Phone:770-252-5279
Practice Address - Fax:770-252-9940
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPT011550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist