Provider Demographics
NPI:1366473985
Name:LEACH, MATTHEW BRIAN (MS,PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BRIAN
Last Name:LEACH
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11503 HOPI CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-5847
Mailing Address - Country:US
Mailing Address - Phone:502-267-1491
Mailing Address - Fax:
Practice Address - Street 1:9368 CEDAR CENTER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4522
Practice Address - Country:US
Practice Address - Phone:502-231-3979
Practice Address - Fax:502-231-9891
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007438A225100000X
KY003741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist