Provider Demographics
NPI:1003292947
Name:MURDOCK, LEAH ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ANN
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 ROOSEVELT HWY
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-4475
Mailing Address - Country:US
Mailing Address - Phone:802-861-3600
Mailing Address - Fax:
Practice Address - Street 1:905 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4475
Practice Address - Country:US
Practice Address - Phone:802-861-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0111687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist