Provider Demographics
NPI:1437821931
Name:JOHNSON, LEIGH (PTA)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 BACKUSBURG RD
Mailing Address - Street 2:
Mailing Address - City:KIRKSEY
Mailing Address - State:KY
Mailing Address - Zip Code:42054-9206
Mailing Address - Country:US
Mailing Address - Phone:270-556-5469
Mailing Address - Fax:
Practice Address - Street 1:2607 MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-7601
Practice Address - Country:US
Practice Address - Phone:270-527-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02992225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty