Provider Demographics
NPI:1154477727
Name:LEJA, GRETCHEN ELAINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ELAINE
Last Name:LEJA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6404 E WILLOW SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-7623
Mailing Address - Country:US
Mailing Address - Phone:480-488-4124
Mailing Address - Fax:480-595-5590
Practice Address - Street 1:8505 E VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-6768
Practice Address - Country:US
Practice Address - Phone:480-484-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ626781OtherAHCCCS