Provider Demographics
NPI:1457850216
Name:NEALEIGH, ETHAN D (ATC)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:D
Last Name:NEALEIGH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 RED RIVER WEST GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LAURA
Mailing Address - State:OH
Mailing Address - Zip Code:45337-9626
Mailing Address - Country:US
Mailing Address - Phone:937-823-3145
Mailing Address - Fax:
Practice Address - Street 1:8591 OAKES RD
Practice Address - Street 2:
Practice Address - City:ARCANUM
Practice Address - State:OH
Practice Address - Zip Code:45304-8904
Practice Address - Country:US
Practice Address - Phone:937-947-1329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer