Provider Demographics
NPI:1023224300
Name:LEACH, CAROL J (PT PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:J
Last Name:LEACH
Suffix:
Gender:F
Credentials:PT PHD
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Mailing Address - Street 1:2010 46TH AVE UNIT 49
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3258
Mailing Address - Country:US
Mailing Address - Phone:970-397-6353
Mailing Address - Fax:970-542-3115
Practice Address - Street 1:920 BARLOW RD
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-4371
Practice Address - Country:US
Practice Address - Phone:970-542-3225
Practice Address - Fax:970-542-3115
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO065359Medicare ID - Type UnspecifiedSUNSET MANOR NURSING HOME