Provider Demographics
NPI:1326724170
Name:LEATH, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:LEATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709B INTERNATIONAL DR STE 38
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-6929
Mailing Address - Country:US
Mailing Address - Phone:313-425-1688
Mailing Address - Fax:
Practice Address - Street 1:709B INTERNATIONAL DR STE 38
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-6929
Practice Address - Country:US
Practice Address - Phone:313-425-1688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier