Provider Demographics
NPI:1285006312
Name:LAGASSE, LEAH ELISE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:ELISE
Last Name:LAGASSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:ELISE
Other - Last Name:MCMILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:501 FOREST LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631
Mailing Address - Country:US
Mailing Address - Phone:864-654-2001
Mailing Address - Fax:800-305-7112
Practice Address - Street 1:95-720 LANIKUHANA AVE
Practice Address - Street 2:STE 140
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2985
Practice Address - Country:US
Practice Address - Phone:808-623-6244
Practice Address - Fax:808-623-6414
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT4089225100000X
SC9232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH3760Medicaid