Provider Demographics
NPI:1316187644
Name:LANDREVILLE, LEAH LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:LEE
Last Name:LANDREVILLE
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 1:111 VISION PARK BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3002
Mailing Address - Country:US
Mailing Address - Phone:936-271-0221
Mailing Address - Fax:936-271-0219
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:936-271-0221
Practice Address - Fax:936-271-0219
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist