Provider Demographics
NPI:1275082984
Name:CAMPEAU, LEANNE (PTA)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:CAMPEAU
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 1:1053 EASTLAND DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6747
Mailing Address - Country:US
Mailing Address - Phone:208-736-9011
Mailing Address - Fax:208-934-9014
Practice Address - Street 1:1053 EASTLAND DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6747
Practice Address - Country:US
Practice Address - Phone:208-736-9011
Practice Address - Fax:208-934-9014
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-181225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant