Provider Demographics
NPI:1043269988
Name:PREMEAU, LEANORA THERESA (MPT)
Entity Type:Individual
Prefix:MS
First Name:LEANORA
Middle Name:THERESA
Last Name:PREMEAU
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2822
Mailing Address - Country:US
Mailing Address - Phone:719-539-2431
Mailing Address - Fax:719-539-3626
Practice Address - Street 1:416 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2822
Practice Address - Country:US
Practice Address - Phone:719-539-2431
Practice Address - Fax:719-539-3626
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic