Provider Demographics
NPI:1023045242
Name:DUGAL, LEAH BRITT (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:BRITT
Last Name:DUGAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 GREENHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9292
Mailing Address - Country:US
Mailing Address - Phone:479-795-1260
Mailing Address - Fax:
Practice Address - Street 1:1601 GREENHOUSE RD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-9292
Practice Address - Country:US
Practice Address - Phone:479-795-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2683225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150150721Medicaid
AR5X534OtherBLUE CROSS BLUE SHEILD