Provider Demographics
NPI:1134653678
Name:KAHAN, LEIBA
Entity Type:Individual
Prefix:
First Name:LEIBA
Middle Name:
Last Name:KAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEIBA
Other - Middle Name:
Other - Last Name:KAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:106 CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-6265
Mailing Address - Country:US
Mailing Address - Phone:561-306-1858
Mailing Address - Fax:
Practice Address - Street 1:1 PEACHTREE DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1200
Practice Address - Country:US
Practice Address - Phone:912-927-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0002694225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant