Provider Demographics
NPI:1114492717
Name:HINSHAW, LEAH MCKINNLEY (PTA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MCKINNLEY
Last Name:HINSHAW
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 1:5254 S NC HIGHWAY 62
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9023
Mailing Address - Country:US
Mailing Address - Phone:336-567-8138
Mailing Address - Fax:
Practice Address - Street 1:4434 OLD BATTLEGROUND RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9828
Practice Address - Country:US
Practice Address - Phone:336-790-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6160225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant