Provider Demographics
NPI:1316042716
Name:DUFRESNE, LEIGH ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH ANN
Middle Name:
Last Name:DUFRESNE
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 1:27 S BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3406
Mailing Address - Country:US
Mailing Address - Phone:610-527-2727
Mailing Address - Fax:610-527-1501
Practice Address - Street 1:27 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3406
Practice Address - Country:US
Practice Address - Phone:610-527-2727
Practice Address - Fax:610-527-1501
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7899888OtherAETNA PPO PIN
PA1894428OtherBC/BS PIN
PA2761542000OtherPERSONAL CHOICE PIN
PA1396329OtherAETNA HMO PIN
PA2761542000OtherKEYSTONE PIN
PA1894428OtherBC/BS PIN