Provider Demographics
NPI:1093947301
Name:COX, LEESA MICHELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LEESA
Middle Name:MICHELLE
Last Name:COX
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 TOWNSHIP ROAD 1153
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9454
Mailing Address - Country:US
Mailing Address - Phone:419-281-1299
Mailing Address - Fax:
Practice Address - Street 1:2010 WALKER LAKE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1412
Practice Address - Country:US
Practice Address - Phone:419-747-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA-02634225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant