Provider Demographics
NPI:1316019243
Name:DESTIGTER, LEAH JO (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:JO
Last Name:DESTIGTER
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 1:1219 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:IA
Mailing Address - Zip Code:51239
Mailing Address - Country:US
Mailing Address - Phone:712-439-9933
Mailing Address - Fax:712-439-2286
Practice Address - Street 1:807 MAIN ST.
Practice Address - Street 2:SUITE C
Practice Address - City:HULL
Practice Address - State:IA
Practice Address - Zip Code:51239
Practice Address - Country:US
Practice Address - Phone:712-439-2266
Practice Address - Fax:712-439-2286
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist