Provider Demographics
NPI:1437249356
Name:HARVEY, LEIGH MARIE (PT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:MARIE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:MISS
Other - First Name:LEIGH
Other - Middle Name:MARIE
Other - Last Name:SWEARENGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC
Mailing Address - Street 1:13801 N BRYANT AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6440
Mailing Address - Country:US
Mailing Address - Phone:405-286-6080
Mailing Address - Fax:866-594-7004
Practice Address - Street 1:13801 N BRYANT AVE
Practice Address - Street 2:STE 400
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6440
Practice Address - Country:US
Practice Address - Phone:405-286-6080
Practice Address - Fax:866-594-7004
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03630225100000X
OK4102225100000X
KS24-005222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200272070AMedicaid
OK200272070AMedicaid
OKOK404509Medicare PIN