Provider Demographics
NPI:1033690342
Name:WISMANN, LEIGHA EVE (ATC)
Entity Type:Individual
Prefix:
First Name:LEIGHA
Middle Name:EVE
Last Name:WISMANN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1635
Mailing Address - Country:US
Mailing Address - Phone:267-909-6929
Mailing Address - Fax:
Practice Address - Street 1:221 STRATFORD RD
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1635
Practice Address - Country:US
Practice Address - Phone:267-909-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer