Provider Demographics
NPI:1164771309
Name:GILLESPIE, LEAH (DPT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MATTHEW LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3254
Mailing Address - Country:US
Mailing Address - Phone:908-451-7278
Mailing Address - Fax:
Practice Address - Street 1:7 CABOT PL
Practice Address - Street 2:3RD FLOOR SUITE A
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4631
Practice Address - Country:US
Practice Address - Phone:508-851-9809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20118OtherPT LICENSE
MA003186002OtherPTAN