Individual
ANGELA SULLIVAN LEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
104 BURNEY DR, FLOWOOD, MS 39232-6621
(601) 987-8202
(601) 718-0293
Mailing address
PO BOX 30594, CHARLOTTE, NC 28230-0594
(601) 987-8202
(601) 718-0293
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
P20610
NC
225100000X
Physical Therapist
Primary
PT7874
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200017063
—
MS
Enumeration date
12/08/2015
Last updated
03/20/2025
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