Provider Demographics
NPI:1417018474
Name:RACZ, LEAH (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:RACZ
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 1:5516 OLD TOWN LN
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8588
Mailing Address - Country:US
Mailing Address - Phone:704-879-4630
Mailing Address - Fax:
Practice Address - Street 1:10616 METROMONT PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7656
Practice Address - Country:US
Practice Address - Phone:704-597-7228
Practice Address - Fax:704-597-9190
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5906-024225100000X
NC11641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40304300Medicaid
WI40304300Medicaid