Provider Demographics
NPI:1093831182
Name:LEFF, GRETCHEN LIANNE (MSPT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LIANNE
Last Name:LEFF
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 SHADOWGRAPH DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-3567
Mailing Address - Country:US
Mailing Address - Phone:408-279-1189
Mailing Address - Fax:
Practice Address - Street 1:3250 CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-0828
Practice Address - Country:US
Practice Address - Phone:408-738-3200
Practice Address - Fax:408-738-1870
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist