Provider Demographics
NPI:1457442873
Name:MCCONNELL, LEAH (MHSPT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MHSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 SEEWEE BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:AWENDAW
Mailing Address - State:SC
Mailing Address - Zip Code:29429-6061
Mailing Address - Country:US
Mailing Address - Phone:843-670-7246
Mailing Address - Fax:
Practice Address - Street 1:751 SEEWEE BLUFF RD
Practice Address - Street 2:
Practice Address - City:AWENDAW
Practice Address - State:SC
Practice Address - Zip Code:29429-6061
Practice Address - Country:US
Practice Address - Phone:843-670-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1087Medicaid