Provider Demographics
NPI:1417003526
Name:TALLEY, LEIGH RANDOLPH (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:RANDOLPH
Last Name:TALLEY
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 1:3131 TALISMAN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1815
Mailing Address - Country:US
Mailing Address - Phone:502-492-2200
Mailing Address - Fax:502-538-2332
Practice Address - Street 1:300 HIGH POINT CT
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-6560
Practice Address - Country:US
Practice Address - Phone:502-538-2332
Practice Address - Fax:502-538-2514
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist