Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TEI001781 | PA |
NPI | 1013359082 |
---|---|
Provider Name | Kelly J Leech |
First Address | Johnstown, PA 15906 |
Second Address | Johnstown, PA 15906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2013 |
Last Update Date | 19/07/2013 |