Provider Demographics
NPI:1346431392
Name:PRICE, LEANDRA SUE (ATC)
Entity Type:Individual
Prefix:
First Name:LEANDRA
Middle Name:SUE
Last Name:PRICE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 EDGEWORTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-2048
Mailing Address - Country:US
Mailing Address - Phone:908-500-8249
Mailing Address - Fax:
Practice Address - Street 1:466 RAIDER BLVD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1443
Practice Address - Country:US
Practice Address - Phone:908-431-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer