Provider Demographics
NPI:1033385943
Name:LEADBITTER SPINE & SPORTS
Entity Type:Organization
Organization Name:LEADBITTER SPINE & SPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-258-9565
Mailing Address - Street 1:104 ROUTE 837
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1034
Mailing Address - Country:US
Mailing Address - Phone:727-258-9565
Mailing Address - Fax:724-258-9036
Practice Address - Street 1:104 ROUTE 837
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1034
Practice Address - Country:US
Practice Address - Phone:727-258-9565
Practice Address - Fax:724-258-9036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005259L302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization