Provider Demographics
NPI:1114770781
Name:HANTMAN, LEAH (CEP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:HANTMAN
Suffix:
Gender:F
Credentials:CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1481
Mailing Address - Country:US
Mailing Address - Phone:508-843-9404
Mailing Address - Fax:
Practice Address - Street 1:50 E MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1481
Practice Address - Country:US
Practice Address - Phone:508-843-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA679334224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist