Individual provider Active NPI

Jeffrey Eugene Leatherman, PT, DPT

  • Physical Therapist
  • Columbus, GA
National Provider Identifier
1417064445
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT017220 Issued in GA
Practice address
1519 13TH Ave
Columbus, GA 31901-1908
Phone
(706) 315-8175
Fax
(888) 337-2181
NPI assigned
Aug 24, 2006
Last updated
Aug 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 8012 NC
Physical Therapist 225100000X PTH9151 AL
Physical Therapist 225100000X PT017220 GA Primary

Addresses

Primary practice location

1519 13TH Ave
Columbus, GA 31901-1908

Mailing address

203 Narrows Pkwy Ste D
Birmingham, AL 35242-8649
Phone (706) 315-8175

Other practice location 1

161 E University Dr
Auburn, AL 36832-5889
Phone (334) 826-2090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190401000369 AL Practitioner - Physical Therapist in Private Practice 1951381417 Reassigns benefits to 1 organization
I20241126002486 GA Practitioner - Physical Therapist in Private Practice 1951381417 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8012NCMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hughston Clinic, P.C. CurrentSince Feb 11, 2019 Accepting new patients
P4 Physical Therapy Limited Partnership Physical Therapist CurrentSince Sep 20, 2024 Accepting new patients
P4 Physical Therapy Limited Partnership Physical Therapist CurrentSince Sep 20, 2024 Accepting new patients
Hughston Clinic, PC CurrentSince Feb 11, 2019 Accepting new patients
Advanced Therapy Physical Therapist Past Accepting new patients
Advanced Therapy, PLLC Physical Therapist PastSince Feb 6, 2002 Accepting new patients

Locations

161 E University Dr
Auburn, AL 36832
Phone (334) 699-5747

203 Narrows Pkwy
Ste D
Birmingham, AL 35242
Phone (205) 719-2420

2257 Taylor Rd
Montgomery, AL 36117
Phone (334) 245-6605

1519 13th Ave
Columbus, GA 31901
Phone (706) 315-8175

6262 Veterans Pkwy
Columbus, GA 31909
Phone (706) 494-3071

6262 Veterans Pkwy
Unit B
Columbus, GA 31909
Phone (706) 494-3434

107 Calumet Center Rd
Lagrange, GA 30241
Phone (706) 884-3274

1805 W Point Rd
Ste A
Lagrange, GA 30240
Phone (706) 845-9383

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1417064445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 NARROWS PKWY STE D",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352428649",
            "telephone_number": "706-315-8175",
            "fax_number": "888-337-2181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 13TH AVE",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319011908",
            "telephone_number": "706-315-8175",
            "fax_number": "888-337-2181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "161 E University Dr",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "AL",
            "postal_code": "368325889",
            "country_code": "US",
            "telephone_number": "334-826-2090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEATHERMAN",
        "first_name": "JEFFREY",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "8012",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH9151",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT017220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.