Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | LPT-30092 | AZ |
N | 225100000X | Physical Therapist | LPT-30092 | AZ |
N | 2251G0304X | Physical Therapist - Geriatrics | LPT-30092 | AZ |
N | 2251N0400X | Physical Therapist - Neurology | LPT-30092 | AZ |
Y | 2251X0800X | Physical Therapist - Orthopedic | LPT-30092 | AZ |
NPI | 1528554334 |
---|---|
Provider Name | Jennifer Leach |
First Address | Mesa, AZ 85209-4971 |
Second Address | Mesa, AZ 85209-5005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2018 |
Last Update Date | 11/01/2022 |