Provider Demographics
NPI:1376738542
Name:WEST, LEAH MARIE (PT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:WEST
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:AZ
Mailing Address - Zip Code:86511-0100
Mailing Address - Country:US
Mailing Address - Phone:928-871-2822
Mailing Address - Fax:
Practice Address - Street 1:1 MILE NORTH OF HWY 264 ON MUSTANG RD
Practice Address - Street 2:
Practice Address - City:ST. MICHAELS
Practice Address - State:AZ
Practice Address - Zip Code:86511
Practice Address - Country:US
Practice Address - Phone:928-871-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist