Provider Demographics
NPI:1982939021
Name:LEDDY, ELIANA (DPT)
Entity type:Individual
Prefix:
First Name:ELIANA
Middle Name:
Last Name:LEDDY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8318
Mailing Address - Country:US
Mailing Address - Phone:802-497-0736
Mailing Address - Fax:802-497-0812
Practice Address - Street 1:266 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8318
Practice Address - Country:US
Practice Address - Phone:802-497-0736
Practice Address - Fax:802-497-0812
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01332800225100000X
VT040.0111025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist